Provider Demographics
NPI:1518030782
Name:KALATSKY, STEWART
Entity Type:Individual
Prefix:
First Name:STEWART
Middle Name:
Last Name:KALATSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1436
Mailing Address - Country:US
Mailing Address - Phone:516-239-0280
Mailing Address - Fax:
Practice Address - Street 1:56 LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1436
Practice Address - Country:US
Practice Address - Phone:516-239-0280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004245174400000X
NY6451500001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01031227Medicaid
NYP44541Medicare ID - Type Unspecified
NYT51401Medicare UPIN
NY02958Medicare ID - Type Unspecified
480006965Medicare PIN