Provider Demographics
NPI:1396744892
Name:GIUDICI, STANLEY C (MD, MAR)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:C
Last Name:GIUDICI
Suffix:
Gender:M
Credentials:MD, MAR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 CRYSTAL RUN ROAD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941
Mailing Address - Country:US
Mailing Address - Phone:845-692-4770
Mailing Address - Fax:845-692-5199
Practice Address - Street 1:111 MALTESE DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2115
Practice Address - Country:US
Practice Address - Phone:845-342-4774
Practice Address - Fax:845-818-7555
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2009-09-15
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
NY2349572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI05494Medicare UPIN