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General NPI Number Information
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NPI Number | 1023230190
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Entity Type | Organization
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Legal Business Name | STONY LODGE MEDICAL GROUP, P.C.
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 40 CROTON DAM ROAD
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City | OSSINING
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State | NY
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Zip | 10562
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Country | US
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Telephone | 914-941-7400
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Fax | 914-941-2437
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Provider Business Mailing Address
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Address Line | PO BOX 1250
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City | BRIARCLIFF MANOR
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State | NY
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Zip | 10510-0327
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Country | US
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Telephone | 914-941-7400
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Fax | 914-941-2437
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KEVIN F. CZIPO
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Credential |
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Telephone | 914-941-7400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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