Healthcare Provider Details

I. General information

NPI: 1063556405
Provider Name (Legal Business Name): ANNE MARIE STILWELL, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 MCCLEAN AVE
STATEN ISLAND NY
10305-4634
US

IV. Provider business mailing address

PO BOX 140057
STATEN ISLAND NY
10314-0057
US

V. Phone/Fax

Practice location:
  • Phone: 718-448-6373
  • Fax: 718-448-6648
Mailing address:
  • Phone: 718-448-6373
  • Fax: 718-448-6648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number186024
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number241180
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number186024
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number186024
License Number StateNY

VIII. Authorized Official

Name: DR. ANNE MARIE STILWELL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-448-6373