Provider Demographics
NPI:1942264510
Name:AYANRUOH, STEVE TENI
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:TENI
Last Name:AYANRUOH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 VERMILYEA AVE FRNT B1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-3209
Mailing Address - Country:US
Mailing Address - Phone:212-544-8854
Mailing Address - Fax:212-544-8867
Practice Address - Street 1:104 VERMILYEA AVE FRNT B1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-3209
Practice Address - Country:US
Practice Address - Phone:212-544-8854
Practice Address - Fax:212-544-8867
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200169-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01621278Medicaid
G21271Medicare UPIN
NY526071Medicare PIN