Provider Demographics
NPI:1720532591
Name:SILVERMAN, STACY
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:SILVERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 JENNINGS CT
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-3025
Mailing Address - Country:US
Mailing Address - Phone:516-528-5935
Mailing Address - Fax:
Practice Address - Street 1:16 JENNINGS CT
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-3025
Practice Address - Country:US
Practice Address - Phone:516-528-5935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist