Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 00SC2101L | PA |
NPI | 1033168380 |
---|---|
Provider Name | Dr. Steven Schutzbank |
First Address | Havertown, PA 19083-1213 |
Second Address | Phila, PA 19151-2206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2006 |
Last Update Date | 15/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00540077 | (05) | PA |
094624 | BLUE SHIELD (01) | PA |
T28482 | (02) | PA |