Provider Demographics
NPI:1295706174
Name:PAIK, STEVE (MD, EDM)
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:PAIK
Suffix:
Gender:M
Credentials:MD, EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3959 BROADWAY
Mailing Address - Street 2:CHN 517
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1559
Mailing Address - Country:US
Mailing Address - Phone:212-305-8504
Mailing Address - Fax:212-305-8881
Practice Address - Street 1:3959 BROADWAY
Practice Address - Street 2:CHN 517
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1559
Practice Address - Country:US
Practice Address - Phone:212-305-8504
Practice Address - Fax:212-305-8881
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225354208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02560814Medicaid
NY640Z71Medicare ID - Type Unspecified
NY02560814Medicaid