Provider Demographics
NPI:1639170889
Name:STERN, DANIEL E (DPM)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:E
Last Name:STERN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MIDDLE COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-4412
Mailing Address - Country:US
Mailing Address - Phone:631-696-9636
Mailing Address - Fax:631-696-9635
Practice Address - Street 1:100 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-4412
Practice Address - Country:US
Practice Address - Phone:631-696-9636
Practice Address - Fax:631-696-9635
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004302213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY198451POtherHIP
NE2496OtherVYTRA
NYPO4302-9OtherWORKER'S COMPENSATION
NYAJ45251OtherMDNY
NY01072059Medicaid
NY1400082OtherGHI
NYCS593OtherOXFORD
NYAETNAOther4207335
NYDSOP240S10OtherBLUE CROSS BLUE SHIELD
NY198451POtherHIP
NY01072059Medicaid