Provider Demographics
NPI:1053411959
Name:STERN, LAWRENCE GARY (DC)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:GARY
Last Name:STERN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-2855
Mailing Address - Country:US
Mailing Address - Phone:914-218-6424
Mailing Address - Fax:
Practice Address - Street 1:121 SMITH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-2855
Practice Address - Country:US
Practice Address - Phone:914-218-6424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX003954-1111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX-22151Medicare ID - Type UnspecifiedCHIROPRACTOR