Provider Demographics
NPI:1659836989
Name:MOSTOFF, STELLA (ANP)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:MOSTOFF
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 LINDENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-2737
Mailing Address - Country:US
Mailing Address - Phone:718-967-1071
Mailing Address - Fax:718-966-0359
Practice Address - Street 1:59 LINDENWOOD RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-2737
Practice Address - Country:US
Practice Address - Phone:718-967-1071
Practice Address - Fax:718-966-0359
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305874-1207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF305874-1OtherNP