Provider Demographics
NPI:1003178302
Name:STERN, DANA LOUISA
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:LOUISA
Last Name:STERN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:LOUISA
Other - Last Name:TUMMOLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:257 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-6703
Mailing Address - Country:US
Mailing Address - Phone:914-402-5519
Mailing Address - Fax:
Practice Address - Street 1:20 CEDAR STREET
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5247
Practice Address - Country:US
Practice Address - Phone:914-576-5292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY794070174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist