Provider Demographics
NPI:1053416909
Name:RAPPAPORT, STUART MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:MICHAEL
Last Name:RAPPAPORT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2127
Mailing Address - Country:US
Mailing Address - Phone:516-374-1010
Mailing Address - Fax:516-374-4383
Practice Address - Street 1:538 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2127
Practice Address - Country:US
Practice Address - Phone:516-374-1010
Practice Address - Fax:516-374-4383
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003912-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00483050Medicaid
NY00483050Medicaid
NYC30341Medicare PIN
NY0912190001Medicare NSC