Basic Information
| Provider Information | |||||||||
| NPI: | 1487739413 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BITTERMAN | ||||||||
| FirstName: | STUART | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 217 STEVEN PL | ||||||||
| Address2: | |||||||||
| City: | WOODMERE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115982532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185446650 | ||||||||
| FaxNumber: | 5165695893 | ||||||||
| Practice Location | |||||||||
| Address1: | 7734 113TH ST | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113757133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185446650 | ||||||||
| FaxNumber: | 5165695893 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 04/27/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 160959 | NY | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 01813794 | 05 | NY | MEDICAID |