Healthcare Provider Details

I. General information

NPI: 1700706850
Provider Name (Legal Business Name): STANLEY WOO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 RUPERT AVE
STATEN ISLAND NY
10314-5052
US

IV. Provider business mailing address

143 RUPERT AVE
STATEN ISLAND NY
10314-5052
US

V. Phone/Fax

Practice location:
  • Phone: 646-645-4017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: