Provider Demographics
NPI:1598751174
Name:KUNSTADT, DOROTHY (MD)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:KUNSTADT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0250
Mailing Address - Country:US
Mailing Address - Phone:212-861-0600
Mailing Address - Fax:212-879-0149
Practice Address - Street 1:927 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0250
Practice Address - Country:US
Practice Address - Phone:212-861-0600
Practice Address - Fax:212-879-0149
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
NY102914174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY911711Medicare ID - Type Unspecified
NYB20069Medicare UPIN