Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 147259 | NY |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 147259 | NY |
NPI | 1063494185 |
---|---|
Provider Name | Kweon Stambaugh |
First Address | Middletown, NY 10941-4028 |
Second Address | Middletown, NY 10941-4028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2005 |
Last Update Date | 12/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02660066 | (05) | NY |
G30660 | (02) | NY |