Provider Demographics
NPI:1750650941
Name:MARJORIE J. VAN DE STOUWE, MD, PC
Entity Type:Organization
Organization Name:MARJORIE J. VAN DE STOUWE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEREA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-872-8235
Mailing Address - Street 1:210 E SUNRISE HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-1329
Mailing Address - Country:US
Mailing Address - Phone:516-872-8235
Mailing Address - Fax:516-825-0045
Practice Address - Street 1:210 E SUNRISE HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1329
Practice Address - Country:US
Practice Address - Phone:516-872-8235
Practice Address - Fax:516-825-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173529207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE38255Medicare UPIN