Healthcare Provider Details

I. General information

NPI: 1255414751
Provider Name (Legal Business Name): GERSON MARC STERNSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 12/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 CHAMBERLAIN HWY
KENSINGTON CT
06037-1921
US

IV. Provider business mailing address

26 CHAMBERLAIN HWY
KENSINGTON CT
06037-1921
US

V. Phone/Fax

Practice location:
  • Phone: 860-893-0040
  • Fax: 860-893-0046
Mailing address:
  • Phone: 860-893-0040
  • Fax: 860-893-0046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number022391
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number022391
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number022391
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number022391
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: