Provider Demographics
NPI:1225094725
Name:SEIDENBERG, ROY STERN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:STERN
Last Name:SEIDENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROY
Other - Middle Name:LEONARD
Other - Last Name:SEIDENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:317 E 34TH ST
Mailing Address - Street 2:11TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4974
Mailing Address - Country:US
Mailing Address - Phone:212-686-7306
Mailing Address - Fax:212-686-7306
Practice Address - Street 1:317 E 34TH ST
Practice Address - Street 2:11TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4974
Practice Address - Country:US
Practice Address - Phone:212-686-7306
Practice Address - Fax:212-686-7306
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191853207N00000X
NJMA066597207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400069035Medicare PIN
NJF91099Medicare UPIN