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General NPI Number Information
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NPI Number | 1144103938
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Entity Type | Organization
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Legal Business Name | THRIVE TELE PSYCHIATRY PLLC
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 85 DENISON PKWY E
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City | CORNING
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State | NY
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Zip | 14830-2726
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Country | US
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Telephone | 607-301-0378
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 455
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City | CORNING
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State | NY
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Zip | 14830-0455
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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 | JAMES STANEK
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Credential |
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Telephone | 503-200-0129
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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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