Healthcare Provider Details

I. General information

NPI: 1851350235
Provider Name (Legal Business Name): STIMSON PRYOR SCHANTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: STIMSON SCHANTZ M.D.

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3916 PRINCE ST STE 152
FLUSHING NY
11354-5367
US

IV. Provider business mailing address

PO BOX 2625
NEW YORK NY
10009-8925
US

V. Phone/Fax

Practice location:
  • Phone: 718-353-7701
  • Fax:
Mailing address:
  • Phone: 914-222-0828
  • Fax: 646-928-2360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number184777
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: