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: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1264 SAINT NICHOLAS AVE STE B
NEW YORK NY
10033-7263
US

IV. Provider business mailing address

PO BOX 32
NORTHBROOK IL
60065-0032
US

V. Phone/Fax

Practice location:
  • Phone: 718-280-4188
  • Fax: 224-235-4652
Mailing address:
  • Phone: 224-318-0118
  • Fax: 847-919-4615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number182239
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: