Provider Demographics
NPI:1336323831
Name:STEIN, EVAN G (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:G
Last Name:STEIN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E 30TH ST
Mailing Address - Street 2:APT. 6M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6416
Mailing Address - Country:US
Mailing Address - Phone:212-779-0829
Mailing Address - Fax:
Practice Address - Street 1:4805 FORT HAMILTON PKWY
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2937
Practice Address - Country:US
Practice Address - Phone:718-283-7199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2374102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology