Healthcare Provider Details

I. General information

NPI: 1790787760
Provider Name (Legal Business Name): ANDREW STERN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date: 03/23/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

20 HAGEN DR. SUITE 300
ROCHESTER NY
14625
US

IV. Provider business mailing address

20 HAGEN DR. SUITE 300
ROCHESTER NY
14625
US

V. Phone/Fax

Practice location:
  • Phone: 585-586-7550
  • Fax: 585-586-7558
Mailing address:
  • Phone: 585-586-7550
  • Fax: 585-586-7588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number143311
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: