Provider Demographics
NPI:1053345108
Name:STATFELD, ITCHIE (MD)
Entity type:Individual
Prefix:DR
First Name:ITCHIE
Middle Name:
Last Name:STATFELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SUMNER PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-4110
Mailing Address - Country:US
Mailing Address - Phone:718-782-5053
Mailing Address - Fax:718-782-0717
Practice Address - Street 1:16 SUMNER PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-4110
Practice Address - Country:US
Practice Address - Phone:718-782-5053
Practice Address - Fax:718-782-0717
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1797252080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E94655Medicare UPIN