Provider Demographics
NPI:1063688596
Name:LEONARD STAMBLER, PHYSICIAN PC
Entity Type:Organization
Organization Name:LEONARD STAMBLER, PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:I
Authorized Official - Last Name:STAMBLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-431-0485
Mailing Address - Street 1:342 W PENN ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3935
Mailing Address - Country:US
Mailing Address - Phone:516-431-0485
Mailing Address - Fax:516-431-9696
Practice Address - Street 1:342 W PENN ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3935
Practice Address - Country:US
Practice Address - Phone:516-431-0485
Practice Address - Fax:516-431-9696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182365207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY23L941Medicare PIN
NYF46638Medicare UPIN