Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 206284-1 | NY |
NPI | 1215951900 |
---|---|
Provider Name | Stephen Fealy |
First Address | New York, NY 10021 |
Second Address | New York, NY 10021-4828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 25/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
408G81 | MEDICARE ID (01) | NY |
H42713 | (02) | NY |