Provider Demographics
NPI:1780673566
Name:FOX, STANLEY ALAN (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:ALAN
Last Name:FOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5023
Mailing Address - Country:US
Mailing Address - Phone:516-797-1234
Mailing Address - Fax:516-797-1932
Practice Address - Street 1:585 BROADWAY
Practice Address - Street 2:BROADWAY INTERNAL MEDICINE ASSOCIATES
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5023
Practice Address - Country:US
Practice Address - Phone:516-797-1234
Practice Address - Fax:516-797-1932
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122154207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00409196Medicaid
C08730Medicare UPIN
33906Medicare ID - Type Unspecified