Healthcare Provider Details

I. General information

NPI: 1861486284
Provider Name (Legal Business Name): ALAN RICHARD STERN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 SOUTHAVEN AVE
MEDFORD NY
11763-3745
US

IV. Provider business mailing address

76 SOUTHAVEN AVE
MEDFORD NY
11763-3745
US

V. Phone/Fax

Practice location:
  • Phone: 631-289-1107
  • Fax: 631-289-1107
Mailing address:
  • Phone: 631-289-1107
  • Fax: 631-289-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN03290
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: