Provider Demographics
NPI:1255339776
Name:STEMPLER, MARK MITCHELL (DPM)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:MITCHELL
Last Name:STEMPLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627D HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4339
Mailing Address - Country:US
Mailing Address - Phone:718-667-6333
Mailing Address - Fax:718-667-6466
Practice Address - Street 1:2627D HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4339
Practice Address - Country:US
Practice Address - Phone:718-667-6333
Practice Address - Fax:718-667-6466
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2023-03-31
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
NYN004914213E00000X, 213ES0131X
NJ25MD00374200213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01284151Medicaid
NYP5509-2Medicare PIN
NYU28705Medicare UPIN