Healthcare Provider Details

I. General information

NPI: 1336384262
Provider Name (Legal Business Name): DR. ALVIN STERN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 12/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 W MAIN ST
PENNS GROVE NJ
08069-1301
US

IV. Provider business mailing address

75 W MAIN ST
PENNS GROVE NJ
08069-1301
US

V. Phone/Fax

Practice location:
  • Phone: 856-299-2112
  • Fax: 856-299-2147
Mailing address:
  • Phone: 856-299-2112
  • Fax: 856-299-2147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberAO 4037
License Number StateNJ

VIII. Authorized Official

Name: DR. ALVIN I STERN
Title or Position: OPTOMETRIST
Credential: OD
Phone: 856-299-2112