Provider Demographics
NPI:1417199027
Name:EMMANUEL ST. LOUIS MD PC
Entity Type:Organization
Organization Name:EMMANUEL ST. LOUIS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-489-3681
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty