Healthcare Provider Details

I. General information

NPI: 1093973448
Provider Name (Legal Business Name): BRIE STOTLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2008
Last Update Date: 05/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST VC 14, 239
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

622 W 168TH ST VC 14, 239
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-8533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number241276-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: