Provider Demographics
NPI:1114937968
Name:ST LOUIS, EMMANUEL (MD)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:
Last Name:ST LOUIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 UNIONDALE AVE
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-3235
Mailing Address - Country:US
Mailing Address - Phone:516-489-3681
Mailing Address - Fax:516-489-3682
Practice Address - Street 1:905 UNIONDALE AVE
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3235
Practice Address - Country:US
Practice Address - Phone:516-489-3681
Practice Address - Fax:516-489-3682
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193946174400000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01517697Medicaid
NYF76442Medicare UPIN
NY80I217Medicare PIN