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General NPI Number Information
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NPI Number | 1770725376
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Entity Type | Organization
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Legal Business Name | STONEYWELL MEDICAL, PC
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Dates
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Enumeration Date | 03/27/2009
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Last Update Date | 03/27/2009
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Provider Practice Location Address
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Address Line | 447 ATLANTIC AVE
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City | BROOKLYN
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State | NY
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Zip | 11217-1702
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Country | US
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Telephone | 631-462-1736
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Fax | 631-462-2266
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Provider Business Mailing Address
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Address Line | 7 STONYWELL CT
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City | DIX HILLS
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State | NY
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Zip | 11746-5421
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Country | US
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Telephone | 631-462-1736
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Fax | 631-462-2266
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SPENCER LUBIN
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Credential | M.D.
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Telephone | 631-462-1736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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