Provider Demographics
NPI:1629402417
Name:TEMPLETON, STEVEN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:TEMPLETON
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 ACKERLY POND LN
Mailing Address - Street 2:PO BOX 1437
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-0938
Mailing Address - Country:US
Mailing Address - Phone:631-765-1414
Mailing Address - Fax:631-765-1428
Practice Address - Street 1:50 ACKERLY POND LN
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-3005
Practice Address - Country:US
Practice Address - Phone:631-765-1414
Practice Address - Fax:631-765-1428
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061843-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant