Provider Demographics
NPI:1528132867
Name:HUBER, MICHAEL STONE (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STONE
Last Name:HUBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 E 93RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1331
Mailing Address - Country:US
Mailing Address - Phone:718-292-5333
Mailing Address - Fax:718-292-5597
Practice Address - Street 1:800 GRAND CONCOURSE
Practice Address - Street 2:SUITE 3
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-3003
Practice Address - Country:US
Practice Address - Phone:718-292-5333
Practice Address - Fax:718-292-5597
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168086207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01363602Medicaid
F36068Medicare UPIN
NY01363602Medicaid