Provider Demographics
NPI:1285795906
Name:STEUBEN PODIATRY NA LLP
Entity type:Organization
Organization Name:STEUBEN PODIATRY NA LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:HATEF
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:607-936-6933
Mailing Address - Street 1:154 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2802
Mailing Address - Country:US
Mailing Address - Phone:607-936-6933
Mailing Address - Fax:607-936-3619
Practice Address - Street 1:154 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2802
Practice Address - Country:US
Practice Address - Phone:607-936-6933
Practice Address - Fax:607-936-3619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2021-10-28
Deactivation Date:2020-11-20
Deactivation Code:
Reactivation Date:2021-04-12
Provider Licenses
StateLicense IDTaxonomies
NYN002447213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0597870001Medicare NSC