Provider Demographics
NPI:1629062187
Name:SHERIS, STEVEN JAY (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JAY
Last Name:SHERIS
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:PRACTICE ASSOCIATES MEDICAL GROUP
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:973-656-6280
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:571 CENTRAL AVE STE 115
Practice Address - Street 2:ASSOCIATES IN CARDIOVASCULAR DISEASE LLC
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1547
Practice Address - Country:US
Practice Address - Phone:908-464-4200
Practice Address - Fax:908-464-1332
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2013-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05375300207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8571406Medicaid
NJ8571406Medicaid
E27446Medicare UPIN
NJ049376QKFMedicare ID - Type Unspecified