Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 166959 | NY |
NPI | 1235170887 |
---|---|
Provider Name | Dr. Stephen Kottmeier |
First Address | Stony Brook, NY 11790-0989 |
Second Address | East Setauket, NY 11733-3472 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01256826 | (05) | NY |
5094244 | AETNA (01) | NY |
89F411 | EMPIRE BC.BS (01) | NY |
E87934 | (02) | NY |