Provider Demographics
NPI:1104944859
Name:STAHL, ROSLYN (MD)
Entity type:Individual
Prefix:DR
First Name:ROSLYN
Middle Name:
Last Name:STAHL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W 107TH ST
Mailing Address - Street 2:APT 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-2717
Mailing Address - Country:US
Mailing Address - Phone:917-771-9508
Mailing Address - Fax:
Practice Address - Street 1:178 E 71ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5131
Practice Address - Country:US
Practice Address - Phone:212-717-2200
Practice Address - Fax:212-717-7377
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08608600207W00000X
NY248819207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03041150Medicaid
NY03041150Medicaid