=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598240194
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT STERNBACH RDCS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2018
-----------------------------------------------------
Last Update Date | 09/28/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1435 SHERWOOD DRIVE
-----------------------------------------------------
City | EAST MEADOW
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11554-1155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-369-7136
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1435 SHERWOOD DR
-----------------------------------------------------
City | EAST MEADOW
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11554-4808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-369-7136
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246XS1301X
-----------------------------------------------------
Taxonomy Name | Sonography Specialist/Technologist Cardiovascular
-----------------------------------------------------
License Number | 38754
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------