Provider Demographics
NPI:1033125174
Name:DEITCH, STEVEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:DEITCH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MAPLE AVENUE
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701
Mailing Address - Country:US
Mailing Address - Phone:732-747-2111
Mailing Address - Fax:732-530-1348
Practice Address - Street 1:130 MAPLE AVENUE
Practice Address - Street 2:SUITE 3B
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701
Practice Address - Country:US
Practice Address - Phone:732-747-2111
Practice Address - Fax:732-530-1348
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00103800213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3325407Medicaid
T77787Medicare UPIN
NJ3325407Medicaid
NJ0675470001Medicare NSC