Provider Demographics
NPI:1902669773
Name:STEP FORWARD PODIATRY PC
Entity type:Organization
Organization Name:STEP FORWARD PODIATRY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DPM., OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NARGIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMUDOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:267-207-3955
Mailing Address - Street 1:963 STREET RD STE 103B
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4728
Mailing Address - Country:US
Mailing Address - Phone:267-207-3955
Mailing Address - Fax:267-805-4501
Practice Address - Street 1:963 STREET RD STE 103B
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4728
Practice Address - Country:US
Practice Address - Phone:267-710-7777
Practice Address - Fax:267-805-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty