Healthcare Provider Details

I. General information

NPI: 1003051236
Provider Name (Legal Business Name): JENNIFER V STERN RPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 - E 25TH STREET 6TH FLOOR
NEW YORK CITY NY
10010
US

IV. Provider business mailing address

51 - E 25TH ST 6TH FL
NEW YORK CITY NY
10010
US

V. Phone/Fax

Practice location:
  • Phone: 212-813-3632
  • Fax: 941-552-8766
Mailing address:
  • Phone: 212-813-3632
  • Fax: 941-552-8766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number008912
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: