Provider Demographics
NPI:1730345968
Name:STEPPING STONE THERAPEUTICS, PLLC
Entity type:Organization
Organization Name:STEPPING STONE THERAPEUTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHADIMA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:716-998-6092
Mailing Address - Street 1:92 RIVERVIEW CT
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-2852
Mailing Address - Country:US
Mailing Address - Phone:716-998-6092
Mailing Address - Fax:716-773-6662
Practice Address - Street 1:92 RIVERVIEW CT
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-2852
Practice Address - Country:US
Practice Address - Phone:716-998-6092
Practice Address - Fax:716-773-6662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013593252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency