Healthcare Provider Details

I. General information

NPI: 1811192834
Provider Name (Legal Business Name): STEVEN B. AXT, DPM, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 PHYLLIS DR SUITE A
PATCHOGUE NY
11772-2900
US

IV. Provider business mailing address

4 PHYLLIS DR SUITE A
PATCHOGUE NY
11772-2900
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 Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number003178-1
License Number StateNY

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. STEVEN B. AXT
Title or Position: DOCTOR
Credential: DPM
Phone: 631-475-3030