Healthcare Provider Details

I. General information

NPI: 1811077530
Provider Name (Legal Business Name): CHAIM A STERN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1839 N RAILROAD AVE
SI NY
10306
US

IV. Provider business mailing address

1839 N RAILROAD AVE
SI NY
10306
US

V. Phone/Fax

Practice location:
  • Phone: 718-979-2121
  • Fax: 718-987-3384
Mailing address:
  • Phone: 718-979-2121
  • Fax: 718-987-3384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0518481
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: