Basic Information
| Provider Information | |||||||||
| NPI: | 1528248341 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STANLEY C. GIUDICI, M.D., M.A.R ., P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 CRYSTAL RUN ROAD | ||||||||
| Address2: | SUITE 125 | ||||||||
| City: | MIDDLETOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109417009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456924770 | ||||||||
| FaxNumber: | 8456925199 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 CRYSTAL RUN ROAD | ||||||||
| Address2: | SUITE 125 | ||||||||
| City: | MIDDLETOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109417009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456924770 | ||||||||
| FaxNumber: | 8456925199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2007 | ||||||||
| LastUpdateDate: | 11/04/2009 | ||||||||
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| AuthorizedOfficialLastName: | PREZIUSO | ||||||||
| AuthorizedOfficialFirstName: | GIULIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8456924770 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | 234957 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Counseling | 2084P0800X | 231466 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 1041C0700X | R0334641 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 2084P0800X | 234957 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 02641303-03 | 05 | NY | MEDICAID |