Provider Demographics
NPI:1003951203
Name:STEPHEN M MULROONEY MD PC
Entity type:Organization
Organization Name:STEPHEN M MULROONEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MULROONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACG
Authorized Official - Phone:212-358-9123
Mailing Address - Street 1:31 WASHINGTON SQ W
Mailing Address - Street 2:SUITE 5F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-9126
Mailing Address - Country:US
Mailing Address - Phone:212-358-9123
Mailing Address - Fax:212-358-1075
Practice Address - Street 1:31 WASHINGTON SQ W
Practice Address - Street 2:SUITE 5F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-9126
Practice Address - Country:US
Practice Address - Phone:212-358-9123
Practice Address - Fax:212-358-1075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168802207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWBW881Medicare PIN