Provider Demographics
NPI:1952466799
Name:STATTER, MINDY BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MINDY
Middle Name:BETH
Last Name:STATTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 EAST 210TH STREET
Mailing Address - Street 2:THE CHILDREN'S HOSPITAL AT MONTEFIORE
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467
Mailing Address - Country:US
Mailing Address - Phone:718-920-7200
Mailing Address - Fax:
Practice Address - Street 1:111 EAST 210TH STREET
Practice Address - Street 2:THE CHILDREN'S HOSPITAL AT MONTEFIORE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-7200
Practice Address - Fax:718-547-2929
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360695262086S0120X
NY2605672086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036069526Medicaid
L91430Medicare ID - Type Unspecified