Provider Demographics
NPI:1104973833
Name:TRUST, STUART (DO)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:
Last Name:TRUST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 SOUTH FIRST ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069
Mailing Address - Country:US
Mailing Address - Phone:315-598-6785
Mailing Address - Fax:315-592-3571
Practice Address - Street 1:63 SOUTH FIRST ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069
Practice Address - Country:US
Practice Address - Phone:315-598-6785
Practice Address - Fax:315-592-3571
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1117151208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
040426016443OtherFIDELIS CARE
100039145101OtherCHILD HEALTH PLUS
00020880201OtherADVANTAGE HEALTH PLAN
000916582001OtherHEALTHNOW
NY00510678Medicaid
4570301OtherAETNA PPO
00020880201OtherUNIVERA
894426OtherAETNA HMO
NY100039145101Medicaid
265841OtherMVP
395OtherTOTAL CARE
154507OtherCIGNA