Provider Demographics
NPI:1760460430
Name:SHERMAN, JOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:SHERMAN
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 1:4143 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-3308
Mailing Address - Country:US
Mailing Address - Phone:718-233-1300
Mailing Address - Fax:718-948-1013
Practice Address - Street 1:2454 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-3117
Practice Address - Country:US
Practice Address - Phone:718-233-1300
Practice Address - Fax:718-980-9728
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2017-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198998174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3122965OtherAETNA
NYP1079060OtherOXFORD
NY01971228Medicaid
NY198998OtherLICENSE NUMBER
NYP1079060OtherOXFORD
NY01971228Medicaid