Provider Demographics
NPI:1295833937
Name:STOOPLER, MARK BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:BENJAMIN
Last Name:STOOPLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:161 FORT WASHINGTON AVE STE 327
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3729
Mailing Address - Country:US
Mailing Address - Phone:212-305-8230
Mailing Address - Fax:212-305-1019
Practice Address - Street 1:161 FORT WASHINGTON AVENUE
Practice Address - Street 2:ROOM 936
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3729
Practice Address - Country:US
Practice Address - Phone:212-305-8230
Practice Address - Fax:212-305-1019
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128446207R00000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00576738Medicaid
B12675Medicare UPIN
NY31A011Medicare ID - Type Unspecified