Provider Demographics
NPI:1376244152
Name:STERN, INNA TABANSKY
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:TABANSKY
Last Name:STERN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:INNA
Other - Middle Name:YURYEVNA
Other - Last Name:TABANSKAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 NICHOLLS RD HSC 09-040
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8093
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 NICHOLLS RD HSC 09-040
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-1916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program