Healthcare Provider Details

I. General information

NPI: 1811171770
Provider Name (Legal Business Name): IRENE GLADSTEIN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2076 E 13TH ST
BROOKLYN NY
11229-3304
US

IV. Provider business mailing address

2076 E 13TH ST
BROOKLYN NY
11229-3304
US

V. Phone/Fax

Practice location:
  • Phone: 718-382-7900
  • Fax: 718-382-7901
Mailing address:
  • Phone: 718-382-7900
  • Fax: 718-382-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number229431
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number229431
License Number StateNY

VIII. Authorized Official

Name: IRENE GLADSTEIN
Title or Position: DIRECTOR
Credential: M.D.
Phone: 718-382-7900