Individual
DR. JAMES EARL STANDEFER JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5 OLD FARM RD, SUITE C2, RED HOOK, NY 12571-1643
(845) 702-3487
(845) 520-9169
Mailing address
PO BOX 4, TIVOLI, NY 12583-0004
(845) 757-2160
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
235444-1
NY
2084P0804X
Child & Adolescent Psychiatry Physician
235444-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03038479
MEDICAID PROVIDER ID
NY
Enumeration date
10/03/2006
Last updated
09/23/2014
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