Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 006356 | NY |
Y | 222Z00000X | Podiatrist | 006356 | NY |
NPI | 1033435219 |
---|---|
Provider Name | Steven T Prak |
First Address | Newport News, VA 23608-0019 |
Second Address | Newport News, VA 23606-1957 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2010 |
Last Update Date | 12/03/2019 |