Healthcare Provider Details

I. General information

NPI: 1366638173
Provider Name (Legal Business Name): TERA NIKOLE HETRICK-STEIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERA NIKOLE HETRICK-STEIN MD

II. Dates (important events)

Enumeration Date: 09/15/2007
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTURY HILL DR STE 5
LATHAM NY
12110-2162
US

IV. Provider business mailing address

10 CENTURY HILL DR STE 5
LATHAM NY
12110-2162
US

V. Phone/Fax

Practice location:
  • Phone: 518-783-5563
  • Fax: 518-782-1540
Mailing address:
  • Phone: 518-783-5563
  • Fax: 518-782-1540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number245727
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: