Provider Demographics
NPI:1063419174
Name:FESSEL, STEVEN E (DPM)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:E
Last Name:FESSEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:STEVEN
Other - Middle Name:E
Other - Last Name:FESSEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:111 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2884
Mailing Address - Country:US
Mailing Address - Phone:845-623-5863
Mailing Address - Fax:845-623-5002
Practice Address - Street 1:111 MAIN ST
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2884
Practice Address - Country:US
Practice Address - Phone:845-623-5863
Practice Address - Fax:845-623-5002
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002847213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP31951Medicare ID - Type Unspecified