Provider Demographics
NPI:1144319096
Name:STALLONE, JAMES ANTHONY (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ANTHONY
Last Name:STALLONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 NORTHERN BLVD STE 328
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5329
Mailing Address - Country:US
Mailing Address - Phone:516-233-2484
Mailing Address - Fax:516-304-5850
Practice Address - Street 1:400 W MAIN ST STE 234
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3009
Practice Address - Country:US
Practice Address - Phone:631-321-4200
Practice Address - Fax:631-321-1594
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170968207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE36694Medicare UPIN
NY38F231Medicare PIN