Provider Demographics
NPI:1598768178
Name:GLADSTONE, LENORE Z (MD)
Entity Type:Individual
Prefix:DR
First Name:LENORE
Middle Name:Z
Last Name:GLADSTONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:701 FAIRWAY GRN
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-4336
Mailing Address - Country:US
Mailing Address - Phone:718-547-8899
Mailing Address - Fax:914-381-6311
Practice Address - Street 1:701 FAIRWAY GRN
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-4336
Practice Address - Country:US
Practice Address - Phone:718-547-8899
Practice Address - Fax:914-381-6311
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2015-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100686208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00172743Medicaid
NY00172743Medicaid
NYB16839Medicare UPIN