Provider Demographics
NPI:1396859583
Name:STAKOFSKY, JOEL IRWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:IRWIN
Last Name:STAKOFSKY
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 1:209 STEINWAY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4820
Mailing Address - Country:US
Mailing Address - Phone:718-698-2211
Mailing Address - Fax:718-698-6289
Practice Address - Street 1:209 STEINWAY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4820
Practice Address - Country:US
Practice Address - Phone:718-698-2211
Practice Address - Fax:718-698-6289
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1547572080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01841905Medicaid
NY01841905Medicaid