Provider Demographics
NPI:1093986887
Name:STEVEN I. SUBOTNICK, DPM,MS A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:STEVEN I. SUBOTNICK, DPM,MS A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUBOTNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-614-5633
Mailing Address - Street 1:13690 E 14TH ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2582
Mailing Address - Country:US
Mailing Address - Phone:510-614-5633
Mailing Address - Fax:510-614-2286
Practice Address - Street 1:13690 E 14TH ST
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2582
Practice Address - Country:US
Practice Address - Phone:510-614-5633
Practice Address - Fax:510-614-2286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1340213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT10901Medicare UPIN
CA1076360001Medicare NSC