Provider Demographics
NPI:1124190228
Name:STERN, LEONARD (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:
Last Name:STERN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W END AVE APT 6S
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6358
Mailing Address - Country:US
Mailing Address - Phone:917-337-2038
Mailing Address - Fax:212-781-7052
Practice Address - Street 1:903 PARK AVE FL 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0362
Practice Address - Country:US
Practice Address - Phone:212-249-8535
Practice Address - Fax:877-526-2985
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129163207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00699101Medicaid
NY00699101Medicaid
NY067A4710Medicare PIN
NYB78892Medicare UPIN