Healthcare Provider Details

I. General information

NPI: 1568473700
Provider Name (Legal Business Name): STEPHEN G HURST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 BRIGHTON 11TH ST FL 7
BROOKLYN NY
11235-5308
US

IV. Provider business mailing address

244 MADISON AVE # 1120
NEW YORK NY
10016-2817
US

V. Phone/Fax

Practice location:
  • Phone: 917-920-3006
  • Fax: 531-200-0034
Mailing address:
  • Phone: 917-920-3006
  • Fax: 212-561-5529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number182239
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number25MA04693100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: