Provider Demographics
NPI:1902997729
Name:STEPHENS-ASHTON, MARJORIE ELAINE (MD)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ELAINE
Last Name:STEPHENS-ASHTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:MARJORIE
Other - Middle Name:ELAINE
Other - Last Name:ASHTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:265 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-4607
Mailing Address - Country:US
Mailing Address - Phone:631-277-5955
Mailing Address - Fax:
Practice Address - Street 1:1869 BRENTWOOD RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4625
Practice Address - Country:US
Practice Address - Phone:631-853-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132482-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01433274Medicaid
NY01433274Medicaid
NY38K281Medicare ID - Type Unspecified