Provider Demographics
NPI:1427118009
Name:STERN, DAVID (PT)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:STERN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8759
Mailing Address - Country:US
Mailing Address - Phone:631-821-2112
Mailing Address - Fax:631-821-5929
Practice Address - Street 1:532 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-8759
Practice Address - Country:US
Practice Address - Phone:631-821-2112
Practice Address - Fax:631-821-5929
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006113-1111N00000X
NY0069402225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04287638Medicaid
NY04310005Medicaid