Provider Demographics
NPI:1962427138
Name:VAN DE STOUWE, MARJORIE J (MD)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:J
Last Name:VAN DE STOUWE
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:210 E SUNRISE HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-1329
Mailing Address - Country:US
Mailing Address - Phone:516-872-8235
Mailing Address - Fax:516-825-0045
Practice Address - Street 1:210 E SUNRISE HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1329
Practice Address - Country:US
Practice Address - Phone:516-872-8235
Practice Address - Fax:516-825-0045
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2014-06-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY173529-1207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE38255Medicare UPIN
NY06F651Medicare ID - Type Unspecified