Provider Demographics
NPI:1184124075
Name:EDRA STERN MD LLC
Entity type:Organization
Organization Name:EDRA STERN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-661-4242
Mailing Address - Street 1:1455 EAST PUTNAM AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-1360
Mailing Address - Country:US
Mailing Address - Phone:203-661-4242
Mailing Address - Fax:203-625-9626
Practice Address - Street 1:1455 EAST PUTNAM AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-1360
Practice Address - Country:US
Practice Address - Phone:203-661-4242
Practice Address - Fax:203-625-9626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty