Provider Demographics
NPI:1700154614
Name:TREITEL, STUART ALLAN (PA)
Entity Type:Individual
Prefix:MR
First Name:STUART
Middle Name:ALLAN
Last Name:TREITEL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 E 13TH ST STE 401
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1901
Mailing Address - Country:US
Mailing Address - Phone:718-258-2588
Mailing Address - Fax:
Practice Address - Street 1:1715 E 13TH ST STE 401
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1901
Practice Address - Country:US
Practice Address - Phone:718-258-2588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21962363AM0700X
NY23-015592363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical