Provider Demographics
NPI:1265433098
Name:KANTERMAN, STUART L (MD)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:L
Last Name:KANTERMAN
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 1:18 HERKIMER AVE
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1525
Mailing Address - Country:US
Mailing Address - Phone:516-931-2959
Mailing Address - Fax:516-935-2919
Practice Address - Street 1:700 OLD COUNTRY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4932
Practice Address - Country:US
Practice Address - Phone:516-681-8899
Practice Address - Fax:516-935-1827
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211907207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY211907OtherLICENSE
NYH27604Medicare UPIN
NY861491Medicare PIN