Provider Demographics
NPI:1497753693
Name:AXT, STEVEN B (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:B
Last Name:AXT
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 1:173 MINEOLA BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2530
Mailing Address - Country:US
Mailing Address - Phone:631-475-3030
Mailing Address - Fax:631-475-3036
Practice Address - Street 1:4 PHYLLIS DR
Practice Address - Street 2:SUITE A3
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2900
Practice Address - Country:US
Practice Address - Phone:631-475-3030
Practice Address - Fax:631-475-3036
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2018-11-05
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
NYN003178213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY480000381OtherMEDICARE RAILROAD
NYP34271Medicare ID - Type Unspecified