Healthcare Provider Details

I. General information

NPI: 1841776952
Provider Name (Legal Business Name): JAY B STAMBLER MD MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 WAVERLY AVENUE BLD 3 STE 1
PATCHOGUE NY
11772-1555
US

IV. Provider business mailing address

450 WAVERLY AVENUE BLD 3 STE 1
PATCHOGUE NY
11772-1555
US

V. Phone/Fax

Practice location:
  • Phone: 631-438-0333
  • Fax: 631-438-0337
Mailing address:
  • Phone: 631-438-0333
  • Fax: 631-438-0337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number135486
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number135486
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JAY B STAMBLER
Title or Position: PRESIDENT
Credential: MD
Phone: 631-438-0333