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General NPI Number Information
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NPI Number | 1104361021
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Entity Type | Organization
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Legal Business Name | MELISSA STOCKMAN ADULT CARE NP PC
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Dates
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Enumeration Date | 01/02/2017
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Last Update Date | 01/02/2017
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Provider Practice Location Address
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Address Line | 152 ISLIP AVE SUITE 23
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City | ISLIP
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State | NY
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Zip | 11751-3225
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Country | US
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Telephone | 613-277-6767
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Fax |
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Provider Business Mailing Address
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Address Line | 41 GREENPORT AVE
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City | MEDFORD
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State | NY
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Zip | 11763-3601
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA STOCKMAN
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Credential | BC-ANP, PNP, RN
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Telephone | 631-758-5635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F302133-1
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License Number State | NY
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