Healthcare Provider Details

I. General information

NPI: 1235614967
Provider Name (Legal Business Name): STACY TSAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 01/19/2025
Certification Date: 01/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL FL 12
NEW YORK NY
10029-6574
US

IV. Provider business mailing address

240 E HURON ST STE 1-200
CHICAGO IL
60611-2909
US

V. Phone/Fax

Practice location:
  • Phone: 212-659-8551
  • Fax:
Mailing address:
  • Phone: 312-503-7975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number330055
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: