Provider Demographics
NPI:1396141628
Name:STIETZLE, LAUREN ASHLEY (PT, DPT, LM, MSM)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ASHLEY
Last Name:STIETZLE
Suffix:
Gender:F
Credentials:PT, DPT, LM, MSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 BRAEMER RD
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3966
Mailing Address - Country:US
Mailing Address - Phone:631-553-6359
Mailing Address - Fax:
Practice Address - Street 1:101 NICOLLS RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-553-6359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-13
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF002369-01176B00000X
NY037259-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No171W00000XOther Service ProvidersContractor