Provider Demographics
NPI:1699769760
Name:STAFFORD, JOHN R JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:STAFFORD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E MAIN ST
Mailing Address - Street 2:NORTHERN WESTCHESTER HOSPITAL 3RD FLOOR
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3417
Mailing Address - Country:US
Mailing Address - Phone:914-666-1272
Mailing Address - Fax:914-666-1002
Practice Address - Street 1:400 E MAIN ST
Practice Address - Street 2:NORTHERN WESTCHESTER HOSPITAL 3RD FLOOR
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3417
Practice Address - Country:US
Practice Address - Phone:914-666-1272
Practice Address - Fax:914-666-1002
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1738532080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0958352OtherAETNA-HMO
5C4323OtherHEALTHNET PIN #
2695234OtherGHI-PPO
10098634-T818OtherCDPHP PIN & GRP #
0000000032942OtherGHI-HMO
WS408OtherOXFORD PIN#
1IJ241OtherEMPIRE BC-BS
4340420OtherAETNA-PPO
NY01141928Medicaid
376982OtherMVP PROVIDER ID #
5C4323OtherHEALTHNET PIN #