Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 1743091 | NY |
NPI | 1023119021 |
---|---|
Provider Name | Dr. Richard Phelps Stankus |
First Address | Liverpool, NY 13088 |
Second Address | Liverpool, NY 13088 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01069745 | (05) | NY |
AS9548857 | DEA (01) | NY |
C67357 | (02) |