Healthcare Provider Details

I. General information

NPI: 1851792972
Provider Name (Legal Business Name): MEREDITH SPENCER STAPLETON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEREDITH SPENCER BEARD

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 E 74TH ST 2ND FLOOR
NEW YORK NY
10021-3235
US

IV. Provider business mailing address

159 E 74TH ST 2ND FLOOR
NEW YORK NY
10021-3235
US

V. Phone/Fax

Practice location:
  • Phone: 212-737-3301
  • Fax: 212-734-0407
Mailing address:
  • Phone: 212-737-3301
  • Fax: 212-734-0407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number018043
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: