Provider Demographics
NPI:1760511968
Name:FAITHFUL STEPS PODIATRY PC
Entity Type:Organization
Organization Name:FAITHFUL STEPS PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-665-5200
Mailing Address - Street 1:40 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8301
Mailing Address - Country:US
Mailing Address - Phone:631-665-5200
Mailing Address - Fax:631-665-4360
Practice Address - Street 1:40 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8301
Practice Address - Country:US
Practice Address - Phone:631-665-5200
Practice Address - Fax:631-665-4360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005930213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PJ7132OtherEMPIRE BCBS
6298837OtherGHI
2122948OtherVYTRA
P0018218OtherRXR MEDICARE
N005930OtherHIP
PJ7131OtherBC BS
6298837OtherGHI
P0018218OtherRXR MEDICARE
N005930OtherHIP