Provider Demographics
NPI:1346392941
Name:DR. DAVID STAMM, DPM, PC
Entity Type:Organization
Organization Name:DR. DAVID STAMM, DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:STAMM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:845-677-3363
Mailing Address - Street 1:28 FRONT ST., BOX J
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:12545
Mailing Address - Country:US
Mailing Address - Phone:845-677-3363
Mailing Address - Fax:845-677-3553
Practice Address - Street 1:28 FRONT ST
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:NY
Practice Address - Zip Code:12545
Practice Address - Country:US
Practice Address - Phone:845-677-3363
Practice Address - Fax:845-677-3553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02618922Medicaid
NYCJ6209OtherMEDICARE RAILROAD
NY02618922Medicaid
NYPHW591Medicare PIN