Healthcare Provider Details

I. General information

NPI: 1407773898
Provider Name (Legal Business Name): STANAIKA CAMPION
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3524 83RD ST FL 3
JACKSON HEIGHTS NY
11372-5229
US

IV. Provider business mailing address

10715 221ST ST
QUEENS VILLAGE NY
11429-2450
US

V. Phone/Fax

Practice location:
  • Phone: 718-639-0700
  • Fax: 718-639-7684
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: