Provider Demographics
NPI:1740445634
Name:HAUSMANN, STACY (MD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:
Last Name:HAUSMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:HAUSMANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:636 MICHELLE PL
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3041
Mailing Address - Country:US
Mailing Address - Phone:516-361-0375
Mailing Address - Fax:
Practice Address - Street 1:636 MICHELLE PL
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581
Practice Address - Country:US
Practice Address - Phone:516-361-0375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006810363A00000X
NY250502208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant