Provider Demographics
NPI:1073552360
Name:NEWMARK, STUART JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:JEFFREY
Last Name:NEWMARK
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 1:2630 MARINA BAY DR E APT 103
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-2334
Mailing Address - Country:US
Mailing Address - Phone:954-496-1934
Mailing Address - Fax:954-791-4400
Practice Address - Street 1:2630 MARINA BAY DR E APT 103
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-2334
Practice Address - Country:US
Practice Address - Phone:954-496-1934
Practice Address - Fax:954-791-4400
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95478207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU7718ZMedicare ID - Type Unspecified
FLI55883Medicare UPIN