Provider Demographics
NPI:1457328858
Name:STEINHAGEN, RANDOLPH (MD)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:
Last Name:STEINHAGEN
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 1:1 GUSTAVE L LEVY PL
Mailing Address - Street 2:BOX 1263
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6574
Mailing Address - Country:US
Mailing Address - Phone:212-241-3328
Mailing Address - Fax:212-241-9042
Practice Address - Street 1:5 EAST 98TH STREET
Practice Address - Street 2:14TH FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6574
Practice Address - Country:US
Practice Address - Phone:212-241-3328
Practice Address - Fax:212-241-9042
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135634208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY30D211Medicare ID - Type Unspecified
B12543Medicare UPIN