Provider Demographics
NPI:1104313428
Name:STUTO, STEVEN LANCE (DPM)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:LANCE
Last Name:STUTO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 PAULDING AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3267
Mailing Address - Country:US
Mailing Address - Phone:917-608-5644
Mailing Address - Fax:
Practice Address - Street 1:100 REMSEN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4213
Practice Address - Country:US
Practice Address - Phone:186-247-5377
Practice Address - Fax:718-624-7538
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY681388359390200000X
NYN00725701213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program