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NPI Code Detail

MEDICARE: STEPHEN KISBERG DPM

MEDICARE: STEPHEN KISBERG DPM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical SuppliesN002365-1NY

General Provider Information

NPI Number : 1700056868
Entity Type Code : Organization
Provider Name (Legal Business Name) : STEPHEN KISBERG DPM
Provider Business Mailing Address
First Line : 11 FRANKLIN PL
Second Line :
City : WOODMERE
State : NY
Zip : 11598-1216
Country : US
Telephone Number : 516-295-2121
Fax Number : 516-295-4727
Provider Business Practice Location Address
First Line : 11 FRANKLIN PL
Second Line :
City : WOODMERE
State : NY
Zip : 11598-1216
Country : US
Telephone Number : 516-295-2121
Fax Number : 516-295-4727
Authorized Official
Title or Position : OFFICE ADMINISTRATOR
Name : CARLENE WALTERS
Credential :
Telephone Number : 516-295-2121
Provider Enumeration Date : 03/05/2008
Last Update Date : 03/05/2008

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