Provider Demographics
NPI: | 1164644589 |
---|---|
Name: | OSTROW, GARY L (DO) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | GARY |
Middle Name: | L |
Last Name: | OSTROW |
Suffix: | |
Gender: | M |
Credentials: | DO |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 625 MADISON AVE |
Mailing Address - Street 2: | STE 10 A |
Mailing Address - City: | NEW YORK |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10022-1801 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 212-838-8265 |
Mailing Address - Fax: | 212-752-5140 |
Practice Address - Street 1: | 625 MADISON AVE |
Practice Address - Street 2: | STE 10 A |
Practice Address - City: | NEW YORK |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10022-1801 |
Practice Address - Country: | US |
Practice Address - Phone: | 212-838-8265 |
Practice Address - Fax: | 212-752-5140 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2007-05-03 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 135373-1 | 207Q00000X, 204D00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Not Answered | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | |
Not Answered | 204D00000X | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 23A181 | Medicare ID - Type Unspecified | |
NY | E51350 | Medicare UPIN |