Active NPI
Eugena Baziuk Stephan, DMD
- Prosthodontics
- Bradford, PA
National Provider Identifier
1508180118
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 40838
- Practice address
- 600 Chestnut Street Ext
Bradford, PA 16701-5438 - Phone
- (814) 362-8478
- NPI assigned
- Mar 25, 2010
- Last updated
- Jul 21, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 40838 | NY | Primary |
Addresses
Primary practice location
600 Chestnut Street Ext
Bradford, PA 16701-5438
Mailing address
600 Chestnut Street Ext
Bradford, PA 16701-5438
Phone (814) 362-8478
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1032395030001 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40838 | NY | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1269475200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1508180118",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 CHESTNUT STREET EXT",
"city": "BRADFORD",
"state": "PA",
"postal_code": "167015438",
"telephone_number": "814-362-8478"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 CHESTNUT STREET EXT",
"city": "BRADFORD",
"state": "PA",
"postal_code": "167015438",
"telephone_number": "814-362-8478"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEPHAN",
"first_name": "EUGENA",
"middle_name": "BAZIUK",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-03-25",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "NY",
"license": "40838",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1032395030001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bradford, PA
- Southern Tier Community Health Center Network Inc (UPC Community Pharmacy - Bradford)
- Southern Tier Community Health Center Network, Inc. (Universal Primary Care)
- Cheri K Sowash, RN
- Rachael Ann Sparks, MS CCC SLP
- Nicole A Stark, RN
- Jackson L Stewart, PSYCHOLOGIST
- Kylie Lauren Stiles, PHARMD
- Alaina Dorothy Strom, CF-SLP
- Erin Strotman, MA, NCC, LPC
- Martha Struchen-Dibble, RN, BC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.