Provider Demographics
NPI:1265535736
Name:STAHL, JEFFREY A (MD FACC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:A
Last Name:STAHL
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1165 NORTHERN BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030
Mailing Address - Country:US
Mailing Address - Phone:516-869-5277
Mailing Address - Fax:516-869-5278
Practice Address - Street 1:1165 NORTHERN BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030
Practice Address - Country:US
Practice Address - Phone:516-869-5277
Practice Address - Fax:516-869-5278
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1655701207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
59F021Medicare ID - Type Unspecified
D91980Medicare UPIN