Provider Demographics
NPI:1598874208
Name:DENSEN, STEPHEN ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ROBERT
Last Name:DENSEN
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 1:27 CROSBY PL
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11724-2404
Mailing Address - Country:US
Mailing Address - Phone:631-334-6507
Mailing Address - Fax:
Practice Address - Street 1:155 MINEOLA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3920
Practice Address - Country:US
Practice Address - Phone:516-741-3338
Practice Address - Fax:516-741-4601
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1057213ES0103X
NY004381213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4414702OtherAETNA
TXOQT12AOtherBLUE CROSS/ BLUE SHEILD
TX121560003Medicaid
TX121560003Medicaid
TXOQT12AOtherBLUE CROSS/ BLUE SHEILD