Provider Demographics
NPI:1124183629
Name:STACKPOLE, SARAH ALICE (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:ALICE
Last Name:STACKPOLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E 79TH ST PH B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1252
Mailing Address - Country:US
Mailing Address - Phone:212-249-9700
Mailing Address - Fax:212-585-2604
Practice Address - Street 1:240 E 79TH ST PH B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1252
Practice Address - Country:US
Practice Address - Phone:212-249-9700
Practice Address - Fax:212-585-2604
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183489207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG47394Medicare UPIN
NYWZTZV1Medicare PIN