Provider Demographics
NPI:1669567814
Name:STADTMAUER, GARY J (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:J
Last Name:STADTMAUER
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 1:115 E 61ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-8183
Mailing Address - Country:US
Mailing Address - Phone:212-486-6715
Mailing Address - Fax:
Practice Address - Street 1:39 BROADWAY
Practice Address - Street 2:#630
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-3003
Practice Address - Country:US
Practice Address - Phone:212-809-1186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184205207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F59101Medicare UPIN