Provider Demographics
NPI:1699983650
Name:PHILLIPS, STEPHANIE BARBARA (DPM)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:BARBARA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DPM
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:140 EINSTEIN LOOP
Mailing Address - Street 2:SUITE 13D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4903
Mailing Address - Country:US
Mailing Address - Phone:917-620-6399
Mailing Address - Fax:718-320-1528
Practice Address - Street 1:140 EINSTEIN LOOP
Practice Address - Street 2:SUITE 13D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4903
Practice Address - Country:US
Practice Address - Phone:917-620-6399
Practice Address - Fax:718-320-1528
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYN004646-1213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPJ9381Medicare UPIN