MEDICARE: DR. STUART LANCE STAUBER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	136356	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699773291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STUART LANCE STAUBER MD

Provider Business Mailing Address
First Line	:	3415 31ST AVE
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-1450
Country	:	US
Telephone Number	:	718-278-2727
Fax Number	:

Provider Business Practice Location Address
First Line	:	3415 31ST AVE
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-1450
Country	:	US
Telephone Number	:	718-278-2727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	01/07/2010

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Directions to “ DR. STUART LANCE STAUBER MD” Practice Location

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