1043996994 NPI number — DR. MICHELLE CECILIA STURCKLER OD

Table of content: DR. MICHELLE CECILIA STURCKLER OD (NPI 1043996994)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043996994 NPI number — DR. MICHELLE CECILIA STURCKLER OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STURCKLER
Provider First Name:
MICHELLE
Provider Middle Name:
CECILIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043996994
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37 BEECHKNOLL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BINGHAMTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13903-3608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-743-1965
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3455 VESTAL PKWY E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VESTAL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13850-2147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-722-2020
Provider Business Practice Location Address Fax Number:
607-722-3937
Provider Enumeration Date:
06/26/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  009779 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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