Basic Information
| Provider Information | |||||||||
| NPI: | 1497740815 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MENITOVE | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 GRAND ST | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | WARWICK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109901035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8459873952 | ||||||||
| FaxNumber: | 8459875979 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 CROSFIELD AVE | ||||||||
| Address2: | SUITE 318 | ||||||||
| City: | WEST NYACK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109942226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453535600 | ||||||||
| FaxNumber: | 8453535668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2005 | ||||||||
| LastUpdateDate: | 03/15/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 1347601 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 0020680 | 01 | GHI HMO | OTHER | 132995699 | 01 | FAM HEALTH PLUS | OTHER | 132995699 | 01 | HUDSON HEALTH PLAN MCD | OTHER | 132995699 | 01 | CIGNA HMO POS | OTHER | 00707906 | 05 | NY | MEDICAID | 0D0736 | 01 | HEALTHNET OF THE NORTHEAS | OTHER | 123214 | 01 | AETNA USHC | OTHER | 132995699 | 01 | HORIZON HEALTHCARE OF NY | OTHER | 132995699 | 01 | INDECS ORANGE ULSTER SCHL | OTHER | 358401 | 01 | BCBS EMPIRE | OTHER | 132995699 | 01 | CIGNA PPO | OTHER | 132995699 | 01 | FEDELIS MEDICAID HMO | OTHER | 132995699 | 01 | LOCAL 1199 | OTHER | 132995699 | 01 | BEECH STREET NETWORK | OTHER | 132995699 | 01 | HEATLH NOW | OTHER | 2900091 | 01 | GHI ALL PLANS EXCEPT HMO | OTHER | 4229785 | 01 | AETNA | OTHER | 0X139P | 01 | HIP | OTHER |