Provider Demographics
NPI:1669679429
Name:NEIL S SNYDER DPM PC
Entity Type:Organization
Organization Name:NEIL S SNYDER DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:636-230-3883
Mailing Address - Street 1:16087 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2103
Mailing Address - Country:US
Mailing Address - Phone:636-230-3883
Mailing Address - Fax:636-230-3884
Practice Address - Street 1:16087 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2103
Practice Address - Country:US
Practice Address - Phone:636-230-3883
Practice Address - Fax:636-230-3884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000660213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO501463806Medicaid
MO4696830001Medicare NSC
MO990001778Medicare ID - Type Unspecified