Healthcare Provider Details

I. General information

NPI: 1528007622
Provider Name (Legal Business Name): STUART T NEVINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 S BROADWAY 3RD FLOOR
WHITE PLAINS NY
10601-4413
US

IV. Provider business mailing address

560 WHITE PLAINS RD SUITE 500
TARRYTOWN NY
10591-5113
US

V. Phone/Fax

Practice location:
  • Phone: 914-949-3888
  • Fax: 914-949-1271
Mailing address:
  • Phone: 914-333-5877
  • Fax: 914-333-2544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number086283
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: