Healthcare Provider Details

I. General information

NPI: 1285620799
Provider Name (Legal Business Name): STUART DEUTSCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1269 E 12TH ST
BROOKLYN NY
11230-4801
US

IV. Provider business mailing address

1269 E 12TH ST
BROOKLYN NY
11230-4801
US

V. Phone/Fax

Practice location:
  • Phone: 718-338-9681
  • Fax: 718-338-9681
Mailing address:
  • Phone: 718-338-9681
  • Fax: 718-338-9681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number151937
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: