Basic Information
| Provider Information | |||||||||
| NPI: | 1306837786 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OUSTATCHER | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 77 QUAKER RIDGE RD | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | NEW ROCHELLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 108042808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146364118 | ||||||||
| FaxNumber: | 9146321304 | ||||||||
| Practice Location | |||||||||
| Address1: | 77 QUAKER RIDGE RD | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | NEW ROCHELLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 108042808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146364118 | ||||||||
| FaxNumber: | 9146321304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 28687 | NY | Y | Dental Providers | Dentist | General Practice |
No ID Information.