Healthcare Provider Details

I. General information

NPI: 1124574355
Provider Name (Legal Business Name): CATHERINE STINSMAN NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 DEER PARK AVE
DEER PARK NY
11729-2700
US

IV. Provider business mailing address

1010 NORTHERN BLVD STE 328
GREAT NECK NY
11021-5329
US

V. Phone/Fax

Practice location:
  • Phone: 631-243-6690
  • Fax: 631-595-1502
Mailing address:
  • Phone: 516-233-2484
  • Fax: 516-304-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF340716-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: