Provider Demographics
NPI:1760658066
Name:LUIS F STILLER MD PC
Entity Type:Organization
Organization Name:LUIS F STILLER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ACEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-296-6926
Mailing Address - Street 1:1865 RANDALL AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-2932
Mailing Address - Country:US
Mailing Address - Phone:646-296-6926
Mailing Address - Fax:718-378-1913
Practice Address - Street 1:1 HAVEN PLAZA
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:NY
Practice Address - Zip Code:10009
Practice Address - Country:US
Practice Address - Phone:212-677-3973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty