Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | C1-0008341 | DE |
N | 207Q00000X | Family Doctor | ME93828 | FL |
Y | 207QS0010X | Family Doctor - Sports Medicine | 250816 | NY |
NPI | 1124129358 |
---|---|
Provider Name | Dr. Stacey Jeanne Pappas |
First Address | West Point, NY 10996-1109 |
Second Address | West Point, NY 10996-1109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 22/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
274079600 | (05) | FL |
I45583 | (02) | FL |