Provider Demographics
NPI:1912193210
Name:STEPHEN N MARSHALL DPM PC
Entity Type:Organization
Organization Name:STEPHEN N MARSHALL DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:315-631-3668
Mailing Address - Street 1:5700 W GENESEE ST
Mailing Address - Street 2:SUITE 221
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031
Mailing Address - Country:US
Mailing Address - Phone:315-631-3668
Mailing Address - Fax:315-631-3670
Practice Address - Street 1:5700 W GENESEE ST
Practice Address - Street 2:SUITE 221
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031
Practice Address - Country:US
Practice Address - Phone:315-631-3668
Practice Address - Fax:315-631-3670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5063810001Medicare NSC
NYAA1095Medicare PIN