Provider Demographics
NPI:1962720359
Name:WEBSTER, STEPHEN (PA-C)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11102-2448
Mailing Address - Country:US
Mailing Address - Phone:718-267-4285
Mailing Address - Fax:
Practice Address - Street 1:561 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3109
Practice Address - Country:US
Practice Address - Phone:212-729-4668
Practice Address - Fax:212-729-8922
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013764363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical