Healthcare Provider Details

I. General information

NPI: 1730133802
Provider Name (Legal Business Name): TATIANA SHTERN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MADISON AVE 1ST FLOOR
PARAMUS NJ
07652-2734
US

IV. Provider business mailing address

22 MADISON AVE 1ST FLOOR
PARAMUS NJ
07652-2734
US

V. Phone/Fax

Practice location:
  • Phone: 201-712-1599
  • Fax: 201-843-7449
Mailing address:
  • Phone: 201-712-1599
  • Fax: 201-843-7449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA71301
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8480401
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: