# MEDICAL ASSOCIATE OF WALL STREET, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912272592
- **Authorized official:** DR. GLENN GANDELMAN M.D. (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (212) 233-3040

## Contact information

- **Practice address:** 6 MAIDEN LN RM 500, NEW YORK, NY 10038-5140
- **Practice address phone:** (212) 233-3040
- **Practice address fax:** (212) 349-7529
- **Mailing address:** 81 HOLLY HILL LN FL 3, GREENWICH, CT 06830-6071
- **Mailing address phone:** (203) 869-8515

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/15/2012
- **Last updated:** 09/20/2022