Provider Demographics
NPI:1407269590
Name:YOLANDA STAHL DPM PC
Entity Type:Organization
Organization Name:YOLANDA STAHL DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:576-379-0815
Mailing Address - Street 1:1457 MERRICK AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566
Mailing Address - Country:US
Mailing Address - Phone:576-379-0815
Mailing Address - Fax:576-379-0872
Practice Address - Street 1:1457 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566
Practice Address - Country:US
Practice Address - Phone:576-379-0815
Practice Address - Fax:576-379-0872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0056720213E00000X
NYN005672213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02D88306Medicaid
NYPB9391Medicare PIN
NYU81525Medicare UPIN