MEDICARE: DR. MICHAEL STERN PH.D.

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	103TC0700X	Clinical Psychologist	5154	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588648471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL STERN PH.D.

Provider Business Mailing Address
First Line	:	203 GRANT ST
Second Line	:
City	:	HAWORTH
State	:	NJ
Zip	:	07641-1426
Country	:	US
Telephone Number	:	201-385-4729
Fax Number	:	201-487-6776

Provider Business Practice Location Address
First Line	:	401 W END AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-5724
Country	:	US
Telephone Number	:	212-787-7492
Fax Number	:	201-487-6776

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

Provider Enumeration Date	:	12/03/2005
Last Update Date	:	01/11/2013

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