1497753693 NPI number — DR. STEVEN B AXT D.P.M.

Table of content: DR. STEVEN B AXT D.P.M. (NPI 1497753693)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497753693 NPI number — DR. STEVEN B AXT D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AXT
Provider First Name:
STEVEN
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497753693
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/16/2006
NPI Reactivation Date:
03/20/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
173 MINEOLA BLVD
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
MINEOLA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11501-2530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-475-3030
Provider Business Mailing Address Fax Number:
631-475-3036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 PHYLLIS DR
Provider Second Line Business Practice Location Address:
SUITE A3
Provider Business Practice Location Address City Name:
PATCHOGUE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11772-2900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-475-3030
Provider Business Practice Location Address Fax Number:
631-475-3036
Provider Enumeration Date:
07/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  N003178 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 480000381 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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