Provider Demographics
NPI:1659863157
Name:HADDAD, STEPHANIE (DPM)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:HADDAD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 HUDSON ST APT 305
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-3648
Mailing Address - Country:US
Mailing Address - Phone:716-912-5877
Mailing Address - Fax:
Practice Address - Street 1:267 BROADWAY FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-6216
Practice Address - Country:US
Practice Address - Phone:716-912-5877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00358800213E00000X
NYN007064213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist