Provider Demographics
NPI:1033270988
Name:WINIARSKI, STEVEN S (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:S
Last Name:WINIARSKI
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 1:2163 HERITAGE DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3560
Mailing Address - Country:US
Mailing Address - Phone:404-642-2983
Mailing Address - Fax:
Practice Address - Street 1:64 BLEECKER ST # 151
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2410
Practice Address - Country:US
Practice Address - Phone:302-313-1584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051569207Q00000X
CT55344207Q00000X
NC2016-01288207Q00000X
NJ25MB09976200207Q00000X
NY274074207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA582307449OtherTAX ID
GA08LCKJMedicare ID - Type Unspecified
GAH48703Medicare UPIN