Healthcare Provider Details

I. General information

NPI: 1922303262
Provider Name (Legal Business Name): BETH STOCKMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 S MANNING BLVD
ALBANY NY
12208-1708
US

IV. Provider business mailing address

314 S MANNING BLVD
ALBANY NY
12208-1708
US

V. Phone/Fax

Practice location:
  • Phone: 518-437-5646
  • Fax: 518-437-5551
Mailing address:
  • Phone: 518-437-5646
  • Fax: 518-437-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number407529
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: