Provider Demographics
NPI:1720450323
Name:STOMBOLY, JANINE DENISE (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:JANINE
Middle Name:DENISE
Last Name:STOMBOLY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14004-9204
Mailing Address - Country:US
Mailing Address - Phone:716-335-5245
Mailing Address - Fax:
Practice Address - Street 1:64 NORTH SHORE DRIVE
Practice Address - Street 2:
Practice Address - City:ALDEN
Practice Address - State:NY
Practice Address - Zip Code:14004-9204
Practice Address - Country:US
Practice Address - Phone:716-335-5245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401894-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health