Healthcare Provider Details

I. General information

NPI: 1700156080
Provider Name (Legal Business Name): MRS. JUDY STOFFEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8442 S MAIN ST
EVANS MILLS NY
13637-3201
US

IV. Provider business mailing address

35 MADISON AVENUE P.O. BOX 673
ANTWERP NY
13608
US

V. Phone/Fax

Practice location:
  • Phone: 315-629-4331
  • Fax:
Mailing address:
  • Phone: 315-659-8401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number305177-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: