Provider Demographics
NPI:1821029026
Name:STAMBLER, JAY B (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:B
Last Name:STAMBLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 E MAIN ST
Mailing Address - Street 2:STE1
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2600
Mailing Address - Country:US
Mailing Address - Phone:631-581-0090
Mailing Address - Fax:631-581-2879
Practice Address - Street 1:126 E MAIN ST
Practice Address - Street 2:STE1
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2600
Practice Address - Country:US
Practice Address - Phone:631-581-0090
Practice Address - Fax:631-581-2879
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135486207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00944005Medicaid
NY64D591Medicare PIN
NYB17415Medicare UPIN