Healthcare Provider Details

I. General information

NPI: 1003731878
Provider Name (Legal Business Name): NICOLE STERNBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 HOLME AVE STE 101
PHILADELPHIA PA
19152-2029
US

IV. Provider business mailing address

1201 LANGHORNE NEWTOWN RD MAIL ROOM
LANGHORNE PA
19047-1201
US

V. Phone/Fax

Practice location:
  • Phone: 267-957-7005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA007662
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: