Provider Demographics
NPI:1396856589
Name:BOHRER, STUART LYLE (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:LYLE
Last Name:BOHRER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:259 1ST ST
Mailing Address - Street 2:WINTHROP HOSPITALDEPARTMENT OF SURGERY
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3957
Mailing Address - Country:US
Mailing Address - Phone:516-663-8700
Mailing Address - Fax:516-487-1058
Practice Address - Street 1:259 1ST ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3957
Practice Address - Country:US
Practice Address - Phone:516-663-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1656132086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00973726Medicaid
NY00973726Medicaid