Healthcare Provider Details

I. General information

NPI: 1366947806
Provider Name (Legal Business Name): ROBERT G STUKE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4433 VESTAL PKWY
VESTAL NY
13850-3556
US

IV. Provider business mailing address

4205 MARIETTA DR
VESTAL NY
13850-4034
US

V. Phone/Fax

Practice location:
  • Phone: 607-772-8772
  • Fax:
Mailing address:
  • Phone: 631-561-7421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number007135
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: