Provider Demographics
NPI:1588648471
Name:STERN, MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:STERN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:HAWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07641-1426
Mailing Address - Country:US
Mailing Address - Phone:201-385-4729
Mailing Address - Fax:201-487-6776
Practice Address - Street 1:401 W END AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5724
Practice Address - Country:US
Practice Address - Phone:212-787-7492
Practice Address - Fax:201-487-6776
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-03
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5154103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01983393Medicaid
NY01983393Medicaid
NYV20131Medicare ID - Type Unspecified