Provider Demographics
NPI:1699078584
Name:CZACHOR, STEPHEN JAMES
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JAMES
Last Name:CZACHOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 NORFOLK CT
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-1636
Mailing Address - Country:US
Mailing Address - Phone:631-949-0799
Mailing Address - Fax:
Practice Address - Street 1:4 NORFOLK CT
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-1636
Practice Address - Country:US
Practice Address - Phone:631-949-0799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303741164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse