Healthcare Provider Details

I. General information

NPI: 1033270988
Provider Name (Legal Business Name): STEVEN S WINIARSKI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 BLEECKER ST # 151
NEW YORK NY
10012-2410
US

IV. Provider business mailing address

2163 HERITAGE DR NE
ATLANTA GA
30345-3560
US

V. Phone/Fax

Practice location:
  • Phone: 302-313-1584
  • Fax:
Mailing address:
  • Phone: 404-642-2983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number051569
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number55344
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2016-01288
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB09976200
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number274074
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: