Provider Demographics
NPI:1841776952
Name:JAY B STAMBLER MD MEDICAL PC
Entity Type:Organization
Organization Name:JAY B STAMBLER MD MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:B
Authorized Official - Last Name:STAMBLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-438-0333
Mailing Address - Street 1:450 WAVERLY AVENUE BLD 3 STE 1
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1555
Mailing Address - Country:US
Mailing Address - Phone:631-438-0333
Mailing Address - Fax:631-438-0337
Practice Address - Street 1:450 WAVERLY AVENUE BLD 3 STE 1
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1555
Practice Address - Country:US
Practice Address - Phone:631-438-0333
Practice Address - Fax:631-438-0337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-12
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135486207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty