Provider Demographics
NPI:1881817351
Name:STERNBERG, MARC BRUCE (EDD, FPPR, FSMI)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:BRUCE
Last Name:STERNBERG
Suffix:
Gender:M
Credentials:EDD, FPPR, FSMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8246 217TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11427-1414
Mailing Address - Country:US
Mailing Address - Phone:718-479-4414
Mailing Address - Fax:718-479-9787
Practice Address - Street 1:21422 73RD AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2914
Practice Address - Country:US
Practice Address - Phone:718-464-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005795103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01619254Medicaid
NY01619254Medicaid
NY46442Medicare ID - Type Unspecified