Provider Demographics
NPI:1346272333
Name:JOHN, STANLEY (MD)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:
Last Name:JOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WASHINGTON CTR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-4627
Mailing Address - Country:US
Mailing Address - Phone:845-563-8000
Mailing Address - Fax:845-565-2968
Practice Address - Street 1:3 WASHINGTON CTR
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-4627
Practice Address - Country:US
Practice Address - Phone:845-563-8000
Practice Address - Fax:845-565-2968
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225651207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00472931Medicaid
I07274Medicare UPIN
NY00472931Medicaid