Provider Demographics
NPI:1023119021
Name:STANKUS, RICHARD PHELPS (PHD MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:PHELPS
Last Name:STANKUS
Suffix:
Gender:M
Credentials:PHD MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7209 BUCKLEY RD SUITE 2X
Mailing Address - Street 2:NORTH MEDICAL CENTER
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088
Mailing Address - Country:US
Mailing Address - Phone:315-452-2070
Mailing Address - Fax:315-452-2074
Practice Address - Street 1:7209 BUCKLEY RD SUITE 2X
Practice Address - Street 2:NORTH MEDICAL CENTER
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088
Practice Address - Country:US
Practice Address - Phone:315-452-2070
Practice Address - Fax:315-452-2074
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1743091207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01069745Medicaid
NY01069745Medicaid
NY51199BMedicare ID - Type Unspecified
NYAS9548857OtherDEA