Provider Demographics
NPI:1700880168
Name:MULROONEY, STEPHEN M (MD,FACG)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:MULROONEY
Suffix:
Gender:M
Credentials:MD,FACG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 WASHINGTON SQ W
Mailing Address - Street 2:APT 5F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-9172
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:APT 5F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-9172
Practice Address - Country:US
Practice Address - Phone:212-358-9123
Practice Address - Fax:212-358-1075
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168802207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1512385Medicaid
NY56K632Medicare ID - Type Unspecified
F26410Medicare UPIN