Provider Demographics
NPI:1861516627
Name:CANTOR, STUART ROY (PHD)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:ROY
Last Name:CANTOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 W 256TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2402
Mailing Address - Country:US
Mailing Address - Phone:718-791-7912
Mailing Address - Fax:718-432-8992
Practice Address - Street 1:3701 HENRY HUDSON PKWY
Practice Address - Street 2:SUITE 1 C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1521
Practice Address - Country:US
Practice Address - Phone:718-791-7912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014347103TC0700X
NJ3980103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ089622Medicare ID - Type Unspecified