Provider Demographics
NPI:1104147545
Name:STIPPA, YURI A (MD)
Entity type:Individual
Prefix:
First Name:YURI
Middle Name:A
Last Name:STIPPA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 HURLEY AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3738
Mailing Address - Country:US
Mailing Address - Phone:845-338-5600
Mailing Address - Fax:
Practice Address - Street 1:40 HURLEY AVE STE 4
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3738
Practice Address - Country:US
Practice Address - Phone:845-338-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH121186207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine