Basic Information
| Provider Information | |||||||||
| NPI: | 1659456028 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STANCOMBE | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | DOMINIC | ||||||||
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| Credential: | RPA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 213 W SUMMIT ST | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147501045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7167631837 | ||||||||
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| Practice Location | |||||||||
| Address1: | 140 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CUBA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147271317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859682000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 05/12/2009 | ||||||||
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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 | 363A00000X | 23-011590 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.