Provider Demographics
NPI:1134125255
Name:RAPOPORT, FREDERICK ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:ALAN
Last Name:RAPOPORT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 COWDIN CIR
Mailing Address - Street 2:
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514-1804
Mailing Address - Country:US
Mailing Address - Phone:646-486-2200
Mailing Address - Fax:646-486-4681
Practice Address - Street 1:36 7TH AVE
Practice Address - Street 2:STE 416
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6688
Practice Address - Country:US
Practice Address - Phone:646-486-2200
Practice Address - Fax:646-486-4681
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14196174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB13772Medicare UPIN