Provider Demographics
NPI:1720148968
Name:HANSEN, ESTHER (DPM)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8301
Mailing Address - Country:US
Mailing Address - Phone:631-665-5200
Mailing Address - Fax:631-665-4360
Practice Address - Street 1:40 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8301
Practice Address - Country:US
Practice Address - Phone:631-665-5200
Practice Address - Fax:631-665-4360
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005930213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
N005930OtherHIP
P0018218OtherRXR MEDICARE
2122948OtherVYTRA
6298837OtherGHI
PJ7132OtherEMPIRE BCBS
U99179Medicare UPIN
5244150001Medicare NSC
P0018218OtherRXR MEDICARE