Provider Demographics
NPI:1821200262
Name:SILVERMAN, IRA STUART
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:STUART
Last Name:SILVERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2821
Mailing Address - Country:US
Mailing Address - Phone:516-767-0007
Mailing Address - Fax:
Practice Address - Street 1:94 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-2821
Practice Address - Country:US
Practice Address - Phone:516-767-0007
Practice Address - Fax:516-767-2326
Is Sole Proprietor?:No
Enumeration Date:2007-05-06
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36236183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist