Provider Demographics
NPI:1417282906
Name:CANTOR-ADKINS, STACEY LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:LYNNE
Last Name:CANTOR-ADKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:STACEY
Other - Middle Name:LYNNE
Other - Last Name:CANTOR-ADKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:430 E 86TH ST
Mailing Address - Street 2:#8A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-6441
Mailing Address - Country:US
Mailing Address - Phone:202-997-0500
Mailing Address - Fax:212-452-0067
Practice Address - Street 1:430 EAST 86TH STREET
Practice Address - Street 2:#8A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-6436
Practice Address - Country:US
Practice Address - Phone:202-997-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD34091208D00000X
PAMD035961E208D00000X
NY169551-12083P0901X
CAG 68191208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice