Provider Demographics
NPI:1013176387
Name:STILES, BRENDON MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:BRENDON
Middle Name:MATTHEW
Last Name:STILES
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 1:525 EAST 68TH STREET
Mailing Address - Street 2:M404
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-4885
Mailing Address - Country:US
Mailing Address - Phone:212-746-5150
Mailing Address - Fax:212-746-8426
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:M404
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-5150
Practice Address - Fax:212-746-8426
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240757208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0167592Medicaid
NY0220AAMedicare PIN
NY5JJ5213551Medicare PIN