Provider Demographics
NPI:1538281712
Name:GARY J. STADTMAUER, MD PLLC
Entity Type:Organization
Organization Name:GARY J. STADTMAUER, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-809-1186
Mailing Address - Street 1:115 E 61ST ST
Mailing Address - Street 2:12TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8183
Mailing Address - Country:US
Mailing Address - Phone:212-486-6715
Mailing Address - Fax:212-935-0092
Practice Address - Street 1:39 BROADWAY
Practice Address - Street 2:SUITE 630
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-3003
Practice Address - Country:US
Practice Address - Phone:212-809-1186
Practice Address - Fax:212-935-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEW431Medicare PIN