Healthcare Provider Details

I. General information

NPI: 1497753693
Provider Name (Legal Business Name): STEVEN B AXT D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date: 03/16/2006
Reactivation Date: 03/20/2006

III. Provider practice location address

4 PHYLLIS DR SUITE A3
PATCHOGUE NY
11772-2900
US

IV. Provider business mailing address

173 MINEOLA BLVD STE 201
MINEOLA NY
11501-2530
US

V. Phone/Fax

Practice location:
  • Phone: 631-475-3030
  • Fax: 631-475-3036
Mailing address:
  • Phone: 631-475-3030
  • Fax: 631-475-3036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN003178
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier480000381
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerMEDICARE RAILROAD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: