Provider Demographics
NPI:1942387253
Name:ADELSON, STEWART LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:LAWRENCE
Last Name:ADELSON
Suffix:
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 1:117 W 17TH ST
Mailing Address - Street 2:STE. 2B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-5409
Mailing Address - Country:US
Mailing Address - Phone:212-924-1460
Mailing Address - Fax:212-924-1460
Practice Address - Street 1:117 W 17TH ST
Practice Address - Street 2:STE. 2B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5409
Practice Address - Country:US
Practice Address - Phone:212-924-1460
Practice Address - Fax:212-924-1460
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1811382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF86592Medicare UPIN