Healthcare Provider Details

I. General information

NPI: 1487937702
Provider Name (Legal Business Name): STEPHANIE BUCK-HASKIN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 06/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NORTHERN BLVD 109
GREAT NECK NY
11021-5206
US

IV. Provider business mailing address

600 NORTHERN BLVD 109
GREAT NECK NY
11021-5206
US

V. Phone/Fax

Practice location:
  • Phone: 516-482-6100
  • Fax: 516-466-7616
Mailing address:
  • Phone: 516-482-6100
  • Fax: 516-466-7616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number150662
License Number StateNY

VIII. Authorized Official

Name: STEPHANIE C. BUCK-HASKIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 516-482-6100