Basic Information
| Provider Information | |||||||||
| NPI: | 1336314871 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STUART NEWMARK PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2480 N FEDERAL HWY | ||||||||
| Address2: | |||||||||
| City: | LIGHTHOUSE POINT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330646812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544961934 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3501 JOHNSON STREET | ||||||||
| Address2: | MEMORIAL REGIONAL HOSPITAL | ||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549872000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2008 | ||||||||
| LastUpdateDate: | 04/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | NEWMARK | ||||||||
| AuthorizedOfficialFirstName: | STUART | ||||||||
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| AuthorizedOfficialTitleorPosition: | INTERNAL MEDICINE | ||||||||
| AuthorizedOfficialTelephone: | 9544961934 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME95478 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2757109-00 | 05 | FL | MEDICAID |