Provider Demographics
NPI:1528248341
Name:STANLEY C. GIUDICI, M.D., M.A.R ., P.C.
Entity type:Organization
Organization Name:STANLEY C. GIUDICI, M.D., M.A.R ., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GIULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PREZIUSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-692-4770
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:10941-7009
Mailing Address - Country:US
Mailing Address - Phone:845-692-4770
Mailing Address - Fax:845-692-5199
Practice Address - Street 1:75 CRYSTAL RUN ROAD
Practice Address - Street 2:SUITE 125
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-7009
Practice Address - Country:US
Practice Address - Phone:845-692-4770
Practice Address - Fax:845-692-5199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234957103TC1900X, 2084P0800X
NY2314662084P0800X
NYR03346411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02641303-03Medicaid
NY105494Medicare UPIN