Healthcare Provider Details

I. General information

NPI: 1255339776
Provider Name (Legal Business Name): MARK MITCHELL STEMPLER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date: 03/15/2006
Reactivation Date: 03/20/2006

III. Provider practice location address

2627D HYLAN BLVD
STATEN ISLAND NY
10306-4339
US

IV. Provider business mailing address

2627D HYLAN BLVD
STATEN ISLAND NY
10306-4339
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-6333
  • Fax: 718-667-6466
Mailing address:
  • Phone: 718-667-6333
  • Fax: 718-667-6466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN004914
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN004914
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00374200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: