Provider Demographics
NPI:1710294632
Name:MITCHELL L. STEINBERG D.P.M., PC
Entity Type:Organization
Organization Name:MITCHELL L. STEINBERG D.P.M., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-751-6665
Mailing Address - Street 1:1212 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-1919
Mailing Address - Country:US
Mailing Address - Phone:631-751-6665
Mailing Address - Fax:631-751-6833
Practice Address - Street 1:1212 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-1919
Practice Address - Country:US
Practice Address - Phone:631-751-6665
Practice Address - Fax:631-751-6833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002518213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004260311Medicaid
NYP28271Medicare PIN
NYT50784Medicare UPIN