Provider Demographics
NPI: | 1033189030 |
---|---|
Name: | EMMETT, STEVEN M (DO) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | STEVEN |
Middle Name: | M |
Last Name: | EMMETT |
Suffix: | |
Gender: | M |
Credentials: | DO |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 3104 QUENTIN ROAD |
Mailing Address - Street 2: | |
Mailing Address - City: | BROOKLYN |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 11234-4209 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 718-339-5544 |
Mailing Address - Fax: | 718-339-4892 |
Practice Address - Street 1: | 3104 QUENTIN ROAD |
Practice Address - Street 2: | |
Practice Address - City: | BROOKLYN |
Practice Address - State: | NY |
Practice Address - Zip Code: | 11234-4209 |
Practice Address - Country: | US |
Practice Address - Phone: | 718-339-5544 |
Practice Address - Fax: | 718-339-4892 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-01-24 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 103132 | 208000000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
101031 | Other | US HEALTH CARE | |
4060662 | Other | AETNA | |
512791 | Other | BLUE CROSS | |
970853 | Other | HERITAGE | |
0381855 | Other | CIGNA | |
P963767 | Other | OXFORD | |
1201394 | Other | UNITED HEALTH CARE | |
OP147 | Other | HIP | |
OP147 | Other | HIP |