Healthcare Provider Details

I. General information

NPI: 1790224756
Provider Name (Legal Business Name): AVICHAI STERN DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 HAVEMEYER ST SUITE 2
BROOKLYN NY
11211-5534
US

IV. Provider business mailing address

161 HAVEMEYER ST SUITE 2
BROOKLYN NY
11211-5534
US

V. Phone/Fax

Practice location:
  • Phone: 718-909-7960
  • Fax:
Mailing address:
  • Phone: 718-909-7960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number051512
License Number StateNY

VIII. Authorized Official

Name: DR. AVICHAI STERN
Title or Position: OWNER
Credential: DDS
Phone: 718-909-7960