Provider Demographics
NPI:1053452177
Name:SHERMAN, STUART ROBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:ROBERT
Last Name:SHERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 366
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4235
Mailing Address - Country:US
Mailing Address - Phone:516-741-1730
Mailing Address - Fax:516-741-5301
Practice Address - Street 1:200 OLD COUNTRY RD
Practice Address - Street 2:SUITE 366
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4235
Practice Address - Country:US
Practice Address - Phone:516-741-1730
Practice Address - Fax:516-741-5301
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175093207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY57K901Medicare ID - Type Unspecified
NYF25761Medicare UPIN