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General NPI Number Information
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NPI Number | 1699983650
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Entity Type | Individual
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Provider Name | STEPHANIE BARBARA PHILLIPS D.P.M.
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Gender | Female
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 10/30/2007
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Provider Practice Location Address
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Address Line | 140 EINSTEIN LOOP SUITE 13D
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City | BRONX
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State | NY
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Zip | 10475-4903
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Country | US
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Telephone | 917-620-6399
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Fax | 718-320-1528
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Provider Business Mailing Address
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Address Line | 140 EINSTEIN LOOP SUITE 13D
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City | BRONX
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State | NY
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Zip | 10475-4903
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Country | US
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Telephone | 917-620-6399
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Fax | 718-320-1528
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | N004646-1
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License Number State | NY
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