Provider Demographics
NPI:1740620939
Name:GUTTENBERG, STACY
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:
Last Name:GUTTENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:GREENSPAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:47 HUMPHREY DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4022
Mailing Address - Country:US
Mailing Address - Phone:516-921-7171
Mailing Address - Fax:516-921-8130
Practice Address - Street 1:47 HUMPHREY DR
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4022
Practice Address - Country:US
Practice Address - Phone:516-921-7171
Practice Address - Fax:516-921-8130
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist