Provider Demographics
NPI:1477612992
Name:PACE, STUART (PHD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:
Last Name:PACE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 FAIRBANKS BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2603
Mailing Address - Country:US
Mailing Address - Phone:516-367-9460
Mailing Address - Fax:
Practice Address - Street 1:35 FAIRBANKS BLVD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2603
Practice Address - Country:US
Practice Address - Phone:516-367-9460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005089103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV16631Medicare ID - Type Unspecified