Individual provider Active NPI

Michael Allen Stillman, MD

  • Dermatology Physician
  • Katonah, NY
National Provider Identifier
1457325839
Registry record updated Mar 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
1012341 Issued in NY
Practice address
111 Bedford Rd
Katonah, NY 10536-2115
Phone
(914) 232-3135
Fax
(914) 242-1516
NPI assigned
Feb 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 1012341 NY Primary
Procedural Dermatology Physician 207NS0135X 1012341 NY

Addresses

Primary practice location

111 Bedford Rd
Katonah, NY 10536-2115

Mailing address

111 Bedford Rd
Katonah, NY 10536-2115
Phone (914) 232-3135

Other identifiers 1

IdentifierTypeStateIssuer
00492333MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1012341NYMDProcedural Dermatology Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206662400000",
    "number": "1457325839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 BEDFORD RD",
            "city": "KATONAH",
            "state": "NY",
            "postal_code": "105362115",
            "telephone_number": "914-232-3135",
            "fax_number": "914-242-1516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 BEDFORD RD",
            "city": "KATONAH",
            "state": "NY",
            "postal_code": "105362115",
            "telephone_number": "914-232-3135",
            "fax_number": "914-242-1516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STILLMAN",
        "first_name": "MICHAEL",
        "middle_name": "ALLEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-14",
        "last_updated": "2008-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NY",
            "license": "1012341",
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NY",
            "license": "1012341",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00492333",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Katonah, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.