Provider Demographics
NPI:1467510115
Name:MYERSON, STEVEN PERRY (DPM)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:PERRY
Last Name:MYERSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 OLD YORK ROAD
Mailing Address - Street 2:SUITE 332
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046
Mailing Address - Country:US
Mailing Address - Phone:215-887-5061
Mailing Address - Fax:215-887-1996
Practice Address - Street 1:261 OLD YORK ROAD
Practice Address - Street 2:SUITE 332
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046
Practice Address - Country:US
Practice Address - Phone:215-887-5061
Practice Address - Fax:215-887-1996
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002040L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00603444Medicaid
T29619Medicare UPIN
PA148104Medicare PIN