Healthcare Provider Details

I. General information

NPI: 1912904392
Provider Name (Legal Business Name): WILLIAM KENNETH STERN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 PHILLIPS HILL RD
NEW CITY NY
10956-4132
US

IV. Provider business mailing address

180 PHILLIPS HILL RD SUITE 4
NEW CITY NY
10956-4132
US

V. Phone/Fax

Practice location:
  • Phone: 845-634-2111
  • Fax: 845-634-5311
Mailing address:
  • Phone: 845-634-2111
  • Fax: 845-634-5311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number90692
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: