Provider Demographics
NPI:1104102409
Name:HINSON-AUSTIN, STACY (PT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:HINSON-AUSTIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 E 33RD ST
Mailing Address - Street 2:4D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9474
Mailing Address - Country:US
Mailing Address - Phone:914-625-2291
Mailing Address - Fax:
Practice Address - Street 1:679 WARBURTON AVE
Practice Address - Street 2:1P
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1662
Practice Address - Country:US
Practice Address - Phone:914-625-2291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027251225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400125974Medicare PIN