Provider Demographics
NPI:1205947306
Name:RESOR, STANLEY R JR (MD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:R
Last Name:RESOR
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:159 W PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-5329
Mailing Address - Country:US
Mailing Address - Phone:203-987-3117
Mailing Address - Fax:203-961-6998
Practice Address - Street 1:22 N STANWICH RD
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-2841
Practice Address - Country:US
Practice Address - Phone:212-305-5459
Practice Address - Fax:212-305-7029
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2017-04-05
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Provider Licenses
StateLicense IDTaxonomies
NY120140-12084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB13513Medicare UPIN
NY346491Medicare ID - Type Unspecified