Provider Demographics
NPI:1710116447
Name:STOLBERG, STEPHANIE (MD)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:
Last Name:STOLBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 WALL ST
Mailing Address - Street 2:APT. 504
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005-3001
Mailing Address - Country:US
Mailing Address - Phone:787-385-6536
Mailing Address - Fax:
Practice Address - Street 1:63 WALL ST
Practice Address - Street 2:APT. 504
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005
Practice Address - Country:US
Practice Address - Phone:787-385-6536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY2722162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program