Healthcare Provider Details

I. General information

NPI: 1629738570
Provider Name (Legal Business Name): HYMAN STADLEN MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 STOWE RD STE 1
PEEKSKILL NY
10566-2582
US

IV. Provider business mailing address

2 STOWE RD STE 1
PEEKSKILL NY
10566-2582
US

V. Phone/Fax

Practice location:
  • Phone: 914-736-2273
  • Fax: 914-736-2511
Mailing address:
  • Phone: 914-736-2273
  • Fax: 914-736-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRISTEN HEAPHY
Title or Position: NURSE PRACTITIONER
Credential: FNP
Phone: 914-482-4133