Healthcare Provider Details

I. General information

NPI: 1831198068
Provider Name (Legal Business Name): STUART M BERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 EXPRESSWAY DR N STE 100
ISLANDIA NY
11749-5301
US

IV. Provider business mailing address

1770 MOTOR PKWY
ISLANDIA NY
11749-5260
US

V. Phone/Fax

Practice location:
  • Phone: 631-434-1770
  • Fax: 631-234-6175
Mailing address:
  • Phone: 631-434-1770
  • Fax: 631-234-6175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number145180
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: