Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | AO 4037 | NJ |
NPI | 1003819236 |
---|---|
Provider Name | Dr. Alvin Ira Stern |
First Address | Penns Grove, NJ 08069-1301 |
Second Address | Penns Grove, NJ 08069-1301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 18/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1514806 | (05) | NJ |
U26911 | (02) |