Provider Demographics
NPI:1649272683
Name:STOCKHEIM, JANET A (MD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:A
Last Name:STOCKHEIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BRADHURST AVE
Mailing Address - Street 2:STE 1400
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2140
Mailing Address - Country:US
Mailing Address - Phone:914-593-8850
Mailing Address - Fax:914-594-3747
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:STE. 800
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-593-8850
Practice Address - Fax:914-594-3747
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195219208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01863827Medicaid
NYG84344Medicare UPIN
NY01863827Medicaid