Provider Demographics
NPI:1952780736
Name:MELISSA STOCKMAN ADULT CARE NP PC
Entity Type:Organization
Organization Name:MELISSA STOCKMAN ADULT CARE NP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:SONYA
Authorized Official - Last Name:STOCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RN CS, ANP, PNP
Authorized Official - Phone:631-758-5635
Mailing Address - Street 1:41 GREENPORT AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-3601
Mailing Address - Country:US
Mailing Address - Phone:631-758-5635
Mailing Address - Fax:
Practice Address - Street 1:41 GREENPORT AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-3601
Practice Address - Country:US
Practice Address - Phone:631-758-5635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302133-1363LA2200X
NYF381245-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty