Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 188332 | NY |
NPI | 1275687444 |
---|---|
Provider Name | Dr. Diane Stumpf-Koster |
First Address | Whitestone, NY 11357-3816 |
Second Address | New York, NY 10032-3722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 08/07/2007 |