Provider Demographics
NPI:1609875657
Name:ENDER, STEVEN A (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:ENDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 HEMPSTEAD TPKE
Mailing Address - Street 2:SUITE 21
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5711
Mailing Address - Country:US
Mailing Address - Phone:516-520-3962
Mailing Address - Fax:516-520-3972
Practice Address - Street 1:4250 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 21
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5711
Practice Address - Country:US
Practice Address - Phone:516-520-3962
Practice Address - Fax:516-520-3972
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1712202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE98902Medicare UPIN