Provider Demographics
NPI:1588739262
Name:COLEMAN, STEPHEN JOEL (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOEL
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MS
Other - First Name:HARRIET
Other - Middle Name:
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 E 33 ST
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-683-3858
Mailing Address - Fax:212-683-1021
Practice Address - Street 1:200 E 33 ST
Practice Address - Street 2:SUITE 2F
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-683-3858
Practice Address - Fax:212-683-1021
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA10202212084P0800X
NYA-1020022-1208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
566531Medicare ID - Type Unspecified
B77802Medicare UPIN