Provider Demographics
NPI:1194731950
Name:SAFTCHICK, STUART LARRY II (MD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:LARRY
Last Name:SAFTCHICK
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STUART
Other - Middle Name:LAWRENCE
Other - Last Name:SAFTCHICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 20585
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0071
Mailing Address - Country:US
Mailing Address - Phone:212-779-4848
Mailing Address - Fax:212-779-3377
Practice Address - Street 1:1387 CASTLE HILL AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-4833
Practice Address - Country:US
Practice Address - Phone:718-931-4200
Practice Address - Fax:718-931-8869
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165660-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01175355Medicaid
NYE49287Medicare UPIN
NY01175355Medicaid