Provider Demographics
NPI:1851375950
Name:SURAN, STEVEN MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MICHAEL
Last Name:SURAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3545
Mailing Address - Country:US
Mailing Address - Phone:516-599-5688
Mailing Address - Fax:516-599-5029
Practice Address - Street 1:215 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3545
Practice Address - Country:US
Practice Address - Phone:516-599-5688
Practice Address - Fax:516-599-5029
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002995213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00406271Medicaid
NYP32542Medicare ID - Type UnspecifiedLOCAL MEDICARE CARRIER ID
NY00406271Medicaid