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General NPI Number Information
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NPI Number | 1174674675
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Entity Type | Organization
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Legal Business Name | BAYPORT PODIATRY ASSOCIATES, PC
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Dates
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Enumeration Date | 01/13/2007
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Last Update Date | 12/10/2021
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Provider Practice Location Address
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Address Line | 39 MONTERREY DR
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City | ST JAMES
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State | NY
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Zip | 11780-3162
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Country | US
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Telephone | 631-275-7935
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Fax | 631-476-6660
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Provider Business Mailing Address
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Address Line | 39 MONTERREY DR
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City | ST JAMES
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State | NY
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Zip | 11780-3162
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Country | US
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Telephone | 631-275-7935
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Fax | 631-476-6660
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Authorized Official
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Title or Position | SECRETARY/PODIATRIST
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Name | DR. DANIEL EFREM STERN
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Credential | DPM
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Telephone | 631-275-7935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | N004302
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License Number State | NY
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