Basic Information
| Provider Information | |||||||||
| NPI: | 1477626703 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODIC | ||||||||
| FirstName: | STANKO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 COULTER ROAD | ||||||||
| Address2: | CLIFTON SPRINGS HOSPITAL & CLINIC ATTN MED STAFF OFF | ||||||||
| City: | CLIFTON SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154621464 | ||||||||
| FaxNumber: | 3154622487 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 COULTER ROAD | ||||||||
| Address2: | BEHAVIORAL HEALTH | ||||||||
| City: | CLIFTON SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154621465 | ||||||||
| FaxNumber: | 3154620145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0802X | 125644 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry |
No ID Information.