Provider Demographics
NPI:1548353675
Name:STELLATO, THOMAS VITO (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:VITO
Last Name:STELLATO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:40 HURLEY AVE
Mailing Address - Street 2:SUITE 17
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3739
Mailing Address - Country:US
Mailing Address - Phone:845-339-6022
Mailing Address - Fax:845-339-5467
Practice Address - Street 1:40 HURLEY AVE
Practice Address - Street 2:SUITE 17
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3739
Practice Address - Country:US
Practice Address - Phone:845-339-6022
Practice Address - Fax:845-339-5467
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY116375-1208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00541433Medicaid
NY00541433Medicaid
3161012501Medicare PIN