Provider Demographics
NPI:1740967793
Name:SKYLAR STONE MD PLLC
Entity type:Organization
Organization Name:SKYLAR STONE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SKYLAR
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-283-4567
Mailing Address - Street 1:20214 45TH AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2540
Mailing Address - Country:US
Mailing Address - Phone:718-283-4567
Mailing Address - Fax:516-699-1102
Practice Address - Street 1:20214 45TH AVE FL 1
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2540
Practice Address - Country:US
Practice Address - Phone:718-283-4567
Practice Address - Fax:516-699-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty