Provider Demographics
NPI:1720083306
Name:KOENIG, STEVEN P (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:P
Last Name:KOENIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E 40TH ST
Mailing Address - Street 2:RM 203
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1201
Mailing Address - Country:US
Mailing Address - Phone:212-889-3550
Mailing Address - Fax:212-696-1190
Practice Address - Street 1:30 E 40TH ST
Practice Address - Street 2:RM 203
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1201
Practice Address - Country:US
Practice Address - Phone:212-889-3550
Practice Address - Fax:212-696-1190
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
NY115847207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
13858OtherANTHEM
7120687008OtherCIGNA HMO AND SENIOR
0013890OtherGHI
0014781OtherAETNA USHEALTHCARE
NS3857OtherOXFORD
4248270OtherAETNA US HEALTHCARE PPO
969461OtherBCBS EMPIRE PLAN
669977OtherUNITED
MT0001479OtherSELECTPRO
115847 24976POtherHIP
969461Medicare ID - Type Unspecified
NS3857OtherOXFORD