Provider Demographics
NPI:1578194783
Name:STAMBLER MEDICAL PC
Entity Type:Organization
Organization Name:STAMBLER MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER / OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-769-6409
Mailing Address - Street 1:450 WAVERLY AVE
Mailing Address - Street 2:BLDG 2 STE 1
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772
Mailing Address - Country:US
Mailing Address - Phone:631-307-9892
Mailing Address - Fax:631-569-5229
Practice Address - Street 1:450 WAVERLY AVE
Practice Address - Street 2:BLDG 2 STE 1
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:631-307-9892
Practice Address - Fax:631-569-5229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty