Healthcare Provider Details

I. General information

NPI: 1861577850
Provider Name (Legal Business Name): JOEL H. STRETCH RPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1927 SARANAC AVE
LAKE PLACID NY
12946-1172
US

IV. Provider business mailing address

224 FLETCHER FARM RD
VERMONTVILLE NY
12989-3521
US

V. Phone/Fax

Practice location:
  • Phone: 518-523-7575
  • Fax:
Mailing address:
  • Phone: 518-891-3384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number02295-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: