Provider Demographics
NPI:1659377661
Name:CEAN, CONRAD (MD)
Entity Type:Individual
Prefix:
First Name:CONRAD
Middle Name:
Last Name:CEAN
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 1:1400 5TH AVENUE
Mailing Address - Street 2:SUITE 3E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026
Mailing Address - Country:US
Mailing Address - Phone:888-789-6672
Mailing Address - Fax:646-862-9066
Practice Address - Street 1:1400 5TH AVE
Practice Address - Street 2:SUITE 3E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-2584
Practice Address - Country:US
Practice Address - Phone:888-789-6672
Practice Address - Fax:646-862-9066
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225389174400000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY30204190Medicaid
NY30204190Medicaid