Provider Demographics
NPI:1669511275
Name:PODELL, DAVID L JR (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:PODELL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 E 78TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0204
Mailing Address - Country:US
Mailing Address - Phone:212-628-2323
Mailing Address - Fax:212-570-9849
Practice Address - Street 1:67 E 78TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0204
Practice Address - Country:US
Practice Address - Phone:212-628-2323
Practice Address - Fax:212-570-9849
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086959207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0076870OtherAETNA
NY46610POtherH.I.P.
NYP378216OtherOXFORD
NY168481OtherEMPIRE
NY00135846Medicaid
NY0C0114OtherPHS
NYB77706Medicare UPIN
NY46610POtherH.I.P.