Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 175093 | NY |
NPI | 1053452177 |
---|---|
Provider Name | Dr. Stuart Robert Sherman |
First Address | Mineola, NY 11501-4235 |
Second Address | Mineola, NY 11501-4235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F25761 | (02) | NY |