Provider Demographics
NPI:1447872684
Name:STERN, NICHOLAS HALEIGH
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:HALEIGH
Last Name:STERN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:HALEIGH
Other - Last Name:STERN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:433 GOODYEAR AVE LOWR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14211-2358
Mailing Address - Country:US
Mailing Address - Phone:716-238-1474
Mailing Address - Fax:
Practice Address - Street 1:433 GOODYEAR AVE LOWR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-2358
Practice Address - Country:US
Practice Address - Phone:716-238-1474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer