Basic Information
| Provider Information | |||||||||
| NPI: | 1437163045 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STETZER | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | JAYNE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 113 HOLLAND AVE | ||||||||
| Address2: | SILVER TEAM, 8C | ||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122083410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5186266030 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 CLARA BARTON DRIVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184398077 | ||||||||
| FaxNumber: | 5184398070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 12/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/26/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 236564 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02727517 | 05 | NY | MEDICAID |