Provider Demographics
NPI:1952322042
Name:BOJSIUK, STEFAN (DPM)
Entity Type:Individual
Prefix:
First Name:STEFAN
Middle Name:
Last Name:BOJSIUK
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 1:30 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:12586-1840
Mailing Address - Country:US
Mailing Address - Phone:845-778-2633
Mailing Address - Fax:845-778-2633
Practice Address - Street 1:30 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WALDEN
Practice Address - State:NY
Practice Address - Zip Code:12586-1840
Practice Address - Country:US
Practice Address - Phone:845-778-2633
Practice Address - Fax:845-778-2633
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004334213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01105980Medicaid
NYT71192Medicare UPIN
NY01105980Medicaid
NYP46591Medicare ID - Type Unspecified