=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225268246
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STUART C SEALFON M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2009
-----------------------------------------------------
Last Update Date | 07/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 E 98TH ST FL 7
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10029-6501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-241-4737
-----------------------------------------------------
Fax | 212-348-1310
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 EAST 98TH STREET, BOX 1137
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10029-6501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-241-4737
-----------------------------------------------------
Fax | 212-348-1310
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 165163
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------