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General NPI Number Information
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NPI Number | 1801182795
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Entity Type | Organization
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Legal Business Name | EDWARD J. STOCKLI, D.C., P.C.
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Dates
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Enumeration Date | 06/20/2011
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Last Update Date | 06/20/2011
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Provider Practice Location Address
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Address Line | 12 CAVALIN DR
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City | MONTGOMERY
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State | NY
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Zip | 12549-2235
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Country | US
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Telephone | 845-457-4447
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Fax | 845-457-1785
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Provider Business Mailing Address
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Address Line | 12 CAVALIN DR
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City | MONTGOMERY
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State | NY
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Zip | 12549-2235
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Country | US
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Telephone | 845-457-4447
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Fax | 845-457-1785
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DONNA VITUCCI
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Credential |
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Telephone | 845-457-4447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X007746-1
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License Number State | NY
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