Provider Demographics
NPI:1407992464
Name:STERN, RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:STERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E 72ND ST
Mailing Address - Street 2:1 J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4650
Mailing Address - Country:US
Mailing Address - Phone:212-879-2282
Mailing Address - Fax:212-794-3236
Practice Address - Street 1:420 E 72ND ST
Practice Address - Street 2:1 J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4650
Practice Address - Country:US
Practice Address - Phone:212-879-2282
Practice Address - Fax:212-794-3236
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109108207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
315171Medicare ID - Type Unspecified
CO8292Medicare UPIN