NPIMap

Organization Active NPI

Sandra Boltax-Stern, MD, PC

  • Child & Adolescent Psychiatry Physician
  • Woodbridge, CT
National Provider Identifier
1972864627
Registry record updated May 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
000011608 Issued in CT
Legal business name
SANDRA BOLTAX-STERN, MD, PC
Practice address
78 Ansonia Road
Woodbridge, CT 06525
Phone
(203) 387-3403
Fax
(203) 387-9125
NPI assigned
May 30, 2012
Last updated
May 30, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Sandra P Boltax-Stern, M.D.NPI 1184656951
Title
President
Phone
(203) 387-3403

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0804X 000011608 CT Primary

Addresses

Primary practice location

78 Ansonia Road
Woodbridge, CT 06525

Mailing address

78 Ansonia Road
Woodbridge, CT 06525
Phone (203) 387-3403

Other identifiers 1

IdentifierTypeStateIssuer
001116086MedicaidCT

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1338336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338336000000",
    "number": "1972864627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "78 ANSONIA ROAD",
            "city": "WOODBRIDGE",
            "state": "CT",
            "postal_code": "06525",
            "telephone_number": "203-387-3403",
            "fax_number": "203-387-9125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78 ANSONIA ROAD",
            "city": "WOODBRIDGE",
            "state": "CT",
            "postal_code": "06525",
            "telephone_number": "203-387-3403",
            "fax_number": "203-387-9125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDRA BOLTAX-STERN, MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-30",
        "last_updated": "2012-05-30",
        "status": "A",
        "authorized_official_last_name": "BOLTAX-STERN",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-387-3403",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "CT",
            "license": "000011608",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001116086",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbridge, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.