Provider Demographics
NPI:1013569193
Name:NEWMAN, MICHAEL J (NP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 GENEVA ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-4721
Mailing Address - Country:US
Mailing Address - Phone:631-383-1553
Mailing Address - Fax:
Practice Address - Street 1:378 SYOSSET WOODBURY RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-1200
Practice Address - Country:US
Practice Address - Phone:516-921-3900
Practice Address - Fax:516-921-8210
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309269363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner