Provider Demographics
NPI:1659573293
Name:ELLEN C. GENDLER, M.D., P.C.
Entity Type:Organization
Organization Name:ELLEN C. GENDLER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:CARYN
Authorized Official - Last Name:GENDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-288-8222
Mailing Address - Street 1:1035 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0135
Mailing Address - Country:US
Mailing Address - Phone:212-288-8222
Mailing Address - Fax:212-988-9640
Practice Address - Street 1:1035 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0135
Practice Address - Country:US
Practice Address - Phone:212-288-8222
Practice Address - Fax:212-988-9640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150962207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB14328Medicare UPIN