Healthcare Provider Details

I. General information

NPI: 1588106645
Provider Name (Legal Business Name): STANLEY JEAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3304 WATERBURY AVE
BRONX NY
10465-1554
US

IV. Provider business mailing address

7 SHERWOOD AVE APT 11
OSSINING NY
10562-3549
US

V. Phone/Fax

Practice location:
  • Phone: 718-931-3000
  • Fax:
Mailing address:
  • Phone: 917-288-7007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number0066711
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: