Provider Demographics
NPI:1295098929
Name:STERN, MIRIAM (MSED)
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:
Last Name:STERN
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 FLINTLOCK DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4129
Mailing Address - Country:US
Mailing Address - Phone:732-908-0811
Mailing Address - Fax:732-901-6640
Practice Address - Street 1:227 FLINTLOCK DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4129
Practice Address - Country:US
Practice Address - Phone:732-908-0811
Practice Address - Fax:732-901-6640
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ00317156174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist