Healthcare Provider Details

I. General information

NPI: 1558696443
Provider Name (Legal Business Name): ROBERT STERN, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 10/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 WHITNEY AVE
NEW HAVEN CT
06511-2317
US

IV. Provider business mailing address

340 WHITNEY AVE
NEW HAVEN CT
06511-2317
US

V. Phone/Fax

Practice location:
  • Phone: 203-562-9110
  • Fax:
Mailing address:
  • Phone: 203-562-9110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number13708
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number13708
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number13708
License Number StateCT

VIII. Authorized Official

Name: DR. ROBERT STERN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 203-562-9110