Basic Information
Provider Information
NPI: 1821656141
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HERROLD
FirstName: STUART
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 90 ADAMS AVE # 110
Address2:  
City: HAUPPAUGE
State: NY
PostalCode: 117883631
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 90 ADAMS AVE # 110
Address2:  
City: HAUPPAUGE
State: NY
PostalCode: 117883631
CountryCode: US
TelephoneNumber: 6319523333
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/01/2019
LastUpdateDate: 06/01/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WP0808X136735-1NYY Nursing Service ProvidersRegistered NursePsych/Mental Health

No ID Information.


Home