Active NPI
Clark Edmon Stull, LMT
- Massage Therapist
- Syracuse, NY
National Provider Identifier
1558671941
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 024325
- Practice address
- 2605 Brewerton Rd
Syracuse, NY 13211-1147 - Phone
- (315) 455-9355
- NPI assigned
- Oct 19, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 024325 | NY | Primary |
Addresses
Primary practice location
2605 Brewerton Rd
Syracuse, NY 13211-1147
Mailing address
17 Flower LN
Marcellus, NY 13108-1346
Phone (315) 380-6719
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 024325 | Other | NY | NY STATE EDUCATION DEPARTMENT |
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)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cltoperations, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Specialist
- Central Square, NY
- NPI 1770892341
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1287446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287446400000",
"number": "1558671941",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 FLOWER LN",
"city": "MARCELLUS",
"state": "NY",
"postal_code": "131081346",
"telephone_number": "315-380-6719"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2605 BREWERTON RD",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132111147",
"telephone_number": "315-455-9355"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STULL",
"first_name": "CLARK",
"middle_name": "EDMON",
"name_prefix": "Mr.",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-10-19",
"last_updated": "2010-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NY",
"license": "024325",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NY STATE EDUCATION DEPARTMENT",
"identifier": "024325",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.