MEDICARE: KATERYNA STERN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1295738	OTHER	NY	PUBLIC SCHOOL TEACHER CERTIFICATE

General Provider Information

NPI Number	:	1235491937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATERYNA STERN

Provider Business Mailing Address
First Line	:	3250 CONEY ISLAND AVE APT 3A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-6612
Country	:	US
Telephone Number	:	347-575-7997
Fax Number	:

Provider Business Practice Location Address
First Line	:	3250 CONEY ISLAND AVE APT 3A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-6612
Country	:	US
Telephone Number	:	347-575-7997
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2012
Last Update Date	:	06/09/2012

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Directions to “ KATERYNA STERN ” Practice Location

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