Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 218319 | NY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 218319 | NY |
NPI | 1376504753 |
---|---|
Provider Name | Scott D Stern |
First Address | Lowville, NY 13367-1297 |
Second Address | Lowville, NY 13367 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 13/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02092648 | (05) | NY |
H25280 | (02) | NY |