Healthcare Provider Details

I. General information

NPI: 1720083306
Provider Name (Legal Business Name): STEVEN P KOENIG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

30 E 40TH ST RM 203
NEW YORK NY
10016-1201
US

IV. Provider business mailing address

30 E 40TH ST RM 203
NEW YORK NY
10016-1201
US

V. Phone/Fax

Practice location:
  • Phone: 212-889-3550
  • Fax: 212-696-1190
Mailing address:
  • Phone: 212-889-3550
  • Fax: 212-696-1190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number115847
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: