Healthcare Provider Details

I. General information

NPI: 1760469779
Provider Name (Legal Business Name): STUART M TASHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 ROUTE 302
CIRCLEVILLE NY
10919-3239
US

IV. Provider business mailing address

111 MALTESE DR
MIDDLETOWN NY
10940-2115
US

V. Phone/Fax

Practice location:
  • Phone: 845-888-2200
  • Fax: 845-888-4202
Mailing address:
  • Phone: 845-342-4774
  • Fax: 845-343-8741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number225542
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02318129
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: