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Organization
MEDICAL ASSOCIATE OF WALL STREET, P.C.
Active
Organization
MEDICAL ASSOCIATE OF WALL STREET, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENN GANDELMAN M.D. (CHIEF EXECUTIVE OFFICER)
(212) 233-3040
Entity
Organization
Contact information
Practice address
6 MAIDEN LN RM 500, NEW YORK, NY 10038-5140
(212) 233-3040
(212) 349-7529
Mailing address
81 HOLLY HILL LN FL 3, GREENWICH, CT 06830-6071
(203) 869-8515
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
NULL
207RC0000X
Cardiovascular Disease Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
NULL
Other
Enumeration date
03/15/2012
Last updated
09/20/2022
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