Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 209791 | NY |
N | 207Q00000X | Family Doctor | 209791 | NY |
NPI | 1154436756 |
---|---|
Provider Name | Dr. Carolyn Ruth Stern |
First Address | Rochester, NY 14618-1030 |
Second Address | Rochester, NY 14611-3201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 02/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BB4202 | MEDICARE PROVIDER NUMBER (01) | NY |
F65360 | (02) | NY |