Provider Demographics
NPI:1902039993
Name:STERN, CHANI MICHELLE (PT)
Entity Type:Individual
Prefix:
First Name:CHANI
Middle Name:MICHELLE
Last Name:STERN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 HARBORVIEW N
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1904
Mailing Address - Country:US
Mailing Address - Phone:917-407-7489
Mailing Address - Fax:
Practice Address - Street 1:168 HARBORVIEW N
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1904
Practice Address - Country:US
Practice Address - Phone:917-407-7489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020028172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker