Provider Demographics
NPI:1134465321
Name:DOCTOR STEPHANIE FAMULARI PODIATRIST PC
Entity Type:Organization
Organization Name:DOCTOR STEPHANIE FAMULARI PODIATRIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PODIATRIC MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAMULARI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-737-8228
Mailing Address - Street 1:1478 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3915
Mailing Address - Country:US
Mailing Address - Phone:718-737-8228
Mailing Address - Fax:
Practice Address - Street 1:1478 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3915
Practice Address - Country:US
Practice Address - Phone:718-737-8228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty