Provider Demographics
NPI:1083680649
Name:LIEDERSON, STUART (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:
Last Name:LIEDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3121 ROUTE 9W
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-6722
Mailing Address - Country:US
Mailing Address - Phone:845-562-2272
Mailing Address - Fax:845-562-1973
Practice Address - Street 1:3121 ROUTE 9W
Practice Address - Street 2:SUITE 104
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-6722
Practice Address - Country:US
Practice Address - Phone:845-562-2272
Practice Address - Fax:845-562-1973
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY209961207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1083680649OtherQUEENS
NY1730276395OtherEMPIRE
NY1730276395OtherEMPIRE