Provider Demographics
NPI:1720487218
Name:JAMES D STERN MD PA
Entity Type:Organization
Organization Name:JAMES D STERN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMROFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-240-3313
Mailing Address - Street 1:1483 COMMODORE WAY
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-5062
Mailing Address - Country:US
Mailing Address - Phone:954-234-3899
Mailing Address - Fax:954-653-1472
Practice Address - Street 1:2699 STIRLING RD STE B101
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6546
Practice Address - Country:US
Practice Address - Phone:954-989-5001
Practice Address - Fax:954-653-1472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57379174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378408800Medicaid
FL17809ZMedicare UPIN