Provider Demographics
NPI:1790887776
Name:PITCOFF, STEPHEN L (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:PITCOFF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8663 HAWKWOOD BAY DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-7822
Mailing Address - Country:US
Mailing Address - Phone:561-200-4531
Mailing Address - Fax:561-200-4531
Practice Address - Street 1:8663 HAWKWOOD BAY DR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33473-7822
Practice Address - Country:US
Practice Address - Phone:561-200-4531
Practice Address - Fax:561-200-4531
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2258213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T50705Medicare UPIN