Provider Demographics
NPI:1073624532
Name:STOCKER, LINDA MANDL (CNM)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MANDL
Last Name:STOCKER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7247-6822
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19170-0001
Mailing Address - Country:US
Mailing Address - Phone:914-241-1050
Mailing Address - Fax:914-242-1516
Practice Address - Street 1:664 STONELEIGH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-3940
Practice Address - Country:US
Practice Address - Phone:845-231-5600
Practice Address - Fax:845-231-5489
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000578176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01462835Medicaid
NYA400116372Medicare PIN