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
StateLicense IDTaxonomies
NY135373-1207Q00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY23A181Medicare ID - Type Unspecified
NYE51350Medicare UPIN