Stackman, Jody M
Stackman, Jody M is an individual health care provider with primary practice located at 8 Brentwood Dr Suite B, Ithaca NY 14850-1871. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology, which is considered as his primary health care specialty. Stackman, Jody M can be contacted via phone (607) 273-6757.Contact Information
Primary practice address
8 Brentwood Dr Suite B
Ithaca NY 14850-1871
Phone: (607) 273-6757
Fax: (607) 273-2854
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neurology | 2084N0400X | 132611 | New York |
Profile Details
| NPI number | 1457353666 |
|---|---|
| LBN Legal business name | Stackman, Jody M |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 1st, 2005 |
| Last updated | Jul 25th, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1457353666 | NPPES |
| New York | MEDICAID | 00711413 |
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