Provider Demographics
NPI:1134272495
Name:STERN, ROBERT GABRIEL (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:GABRIEL
Last Name:STERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DOROLEE DRIVE
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICH
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:732-881-3280
Mailing Address - Fax:732-951-1795
Practice Address - Street 1:376 SEGUINE AVE
Practice Address - Street 2:STATEN ISLAND UNIVERSITY HOSPITAL
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3942
Practice Address - Country:US
Practice Address - Phone:718-226-2351
Practice Address - Fax:718-226-2826
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA069648002084P0800X
NY1980772084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01663634Medicaid
NY01663634Medicaid
G42202Medicare UPIN