Individual
JACOB S STEVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
622 W 168TH ST, NEW YORK, NY 10032-3720
(212) 305-5960
(212) 305-8466
Mailing address
630 W 168TH ST # 4, NEW YORK, NY 10032-3725
(212) 305-5960
(212) 305-8466
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
293294
NY
207R00000X
Internal Medicine Physician
L-255747
MA
207RN0300X
Nephrology Physician
Primary
293294
NY
Other
Enumeration date
06/28/2013
Last updated
03/30/2020
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