Healthcare Provider Details

I. General information

NPI: 1528482312
Provider Name (Legal Business Name): PHILLIP STAMATIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 SOUTH RD
POUGHKEEPSIE NY
12601-6027
US

IV. Provider business mailing address

HUDSON VIEW DRIVE, APT 30 E
BEACON NY
12508-1329
US

V. Phone/Fax

Practice location:
  • Phone: 845-454-0120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number002464-1
License Number StateNY

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: