Provider Demographics
NPI:1174674675
Name:BAYPORT PODIATRY ASSOCIATES, PC
Entity Type:Organization
Organization Name:BAYPORT PODIATRY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:EFREM
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-275-7935
Mailing Address - Street 1:39 MONTERREY DR
Mailing Address - Street 2:
Mailing Address - City:ST JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-3162
Mailing Address - Country:US
Mailing Address - Phone:631-275-7935
Mailing Address - Fax:631-476-6660
Practice Address - Street 1:39 MONTERREY DR
Practice Address - Street 2:
Practice Address - City:ST JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-3162
Practice Address - Country:US
Practice Address - Phone:631-275-7935
Practice Address - Fax:631-476-6660
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAYPORT PODIATRY ASSOCIATES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-13
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004302213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty