Healthcare Provider Details

I. General information

NPI: 1285876805
Provider Name (Legal Business Name): SIDNEY S STERNBERGER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1097 OLD COUNTRY RD STE 209
PLAINVIEW NY
11803
US

IV. Provider business mailing address

1097 OLD COUNTRY RD STE 209
PLAINVIEW NY
11803-6505
US

V. Phone/Fax

Practice location:
  • Phone: 917-620-4577
  • Fax: 516-931-6608
Mailing address:
  • Phone: 917-620-4577
  • Fax: 516-931-2290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number054486
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number054486
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: