Healthcare Provider Details

I. General information

NPI: 1407068588
Provider Name (Legal Business Name): GARY OSTROW, D O PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E 57TH ST 16TH FLOOR
NEW YORK NY
10022-2049
US

IV. Provider business mailing address

115 E 57TH ST 16TH FLOOR
NEW YORK NY
10022-2049
US

V. Phone/Fax

Practice location:
  • Phone: 212-838-8265
  • Fax: 212-752-5140
Mailing address:
  • Phone: 212-838-8265
  • Fax: 212-752-5140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number135373-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number135373-1
License Number StateNY

VIII. Authorized Official

Name: DR. GARY L. OSTROW
Title or Position: PRESIDENT
Credential: D.O.
Phone: 212-838-8265