Provider Demographics
NPI:1437182375
Name:STERN, JORDAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:C
Last Name:STERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:15 BROAD ST APT 2414
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005-1989
Mailing Address - Country:US
Mailing Address - Phone:212-683-0174
Mailing Address - Fax:646-731-6880
Practice Address - Street 1:245 5TH AVE FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8728
Practice Address - Country:US
Practice Address - Phone:212-683-0174
Practice Address - Fax:646-731-6880
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167464207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01401005Medicaid
F20122Medicare UPIN