DR. WANIDA STOUTENBURG DPM NPI 1447316021

NPI Information

  • NPI: 1447316021
  • Provider Name: DR. WANIDA STOUTENBURG, DPM
  • Classification: Podiatrist - 213E00000X
  • Entity Type: Individual
  • Address: 65 BLOOMINGDALE RD
    TILLSON, NY
    ZIP 12486
  • Phone: (845) 658-8415

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NPI Details

DR. Wanida Stoutenburg, DPM is a podiatrist in Tillson, NY. The provider is a podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. DR. Wanida Stoutenburg, DPM NPI is 1447316021. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

65 BLOOMINGDALE RD
TILLSON, NY
ZIP 12486-307
Phone: (845) 658-8415

The enumeration date for this NPI number is 12/28/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1213E00000XPodiatristN005408NEW YORKYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1P00751MEDICARE ID-TYPE UNSPECIFIEDNEW YORKEMPIRE MEDICARE PROVIDER
201779322MEDICAIDNEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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