Provider Demographics
NPI:1811192834
Name:STEVEN B. AXT, DPM, P.C.
Entity Type:Organization
Organization Name:STEVEN B. AXT, DPM, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:AXT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-475-3030
Mailing Address - Street 1:4 PHYLLIS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2900
Mailing Address - Country:US
Mailing Address - Phone:631-475-3030
Mailing Address - Fax:631-475-3036
Practice Address - Street 1:4 PHYLLIS DR
Practice Address - Street 2:SUITE A
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2900
Practice Address - Country:US
Practice Address - Phone:631-475-3030
Practice Address - Fax:631-475-3036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003178-1213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP34271Medicare ID - Type Unspecified
NYT51011Medicare UPIN