Healthcare Provider Details

I. General information

NPI: 1134272495
Provider Name (Legal Business Name): ROBERT GABRIEL STERN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 06/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 SEGUINE AVE STATEN ISLAND UNIVERSITY HOSPITAL
STATEN ISLAND NY
10309-3942
US

IV. Provider business mailing address

10 DOROLEE DRIVE
EAST BRUNSWICH NJ
08816
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-2351
  • Fax: 718-226-2826
Mailing address:
  • Phone: 732-881-3280
  • Fax: 732-951-1795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA06964800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number198077
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: