Provider Demographics
NPI:1861486284
Name:STERN, ALAN RICHARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:RICHARD
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 1:76 SOUTHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-3745
Mailing Address - Country:US
Mailing Address - Phone:631-289-1107
Mailing Address - Fax:631-289-1107
Practice Address - Street 1:76 SOUTHAVEN AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-3745
Practice Address - Country:US
Practice Address - Phone:631-289-1107
Practice Address - Fax:631-289-1107
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN03290213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00709435Medicaid
T51038Medicare UPIN
P35011Medicare ID - Type Unspecified