Basic Information
Provider Information
NPI: 1184231185
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STERN
FirstName: ASHLEY
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential: NP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10 UNION SQ E
Address2:  
City: NEW YORK
State: NY
PostalCode: 100033314
CountryCode: US
TelephoneNumber: 2128448100
FaxNumber:  
Practice Location
Address1: 10 UNION SQ E
Address2:  
City: NEW YORK
State: NY
PostalCode: 100033314
CountryCode: US
TelephoneNumber: 2128448100
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/24/2020
LastUpdateDate: 06/25/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/25/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X793047NYN Nursing Service ProvidersRegistered Nurse 
363LA2200X309989NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health

No ID Information.


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