Provider Demographics
NPI:1609647866
Name:LEGACY MEDICAL PLLC
Entity Type:Organization
Organization Name:LEGACY MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:YANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHTERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-209-9990
Mailing Address - Street 1:11380 PROSPERITY FARMS RD STE 114
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3464
Mailing Address - Country:US
Mailing Address - Phone:917-209-9990
Mailing Address - Fax:
Practice Address - Street 1:11380 PROSPERITY FARMS RD STE 114
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3464
Practice Address - Country:US
Practice Address - Phone:917-209-9990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty