Healthcare Provider Details

I. General information

NPI: 1497856629
Provider Name (Legal Business Name): STEPHEN H SHERRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 HIGHLAND AVE
GLEN RIDGE NJ
07028-1527
US

IV. Provider business mailing address

PO BOX 419430
BOSTON MA
02241-9430
US

V. Phone/Fax

Practice location:
  • Phone: 973-744-3733
  • Fax: 973-707-5821
Mailing address:
  • Phone: 201-666-3900
  • Fax: 201-261-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number25MA03892900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: