Provider Demographics
NPI:1801863295
Name:STAPEN, RICHARD LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LAWRENCE
Last Name:STAPEN
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 1:4160 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6000
Mailing Address - Country:US
Mailing Address - Phone:516-797-6700
Mailing Address - Fax:516-797-8463
Practice Address - Street 1:4160 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6000
Practice Address - Country:US
Practice Address - Phone:516-797-6700
Practice Address - Fax:516-797-8463
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1312112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00525833Medicaid
NY00525833Medicaid
NY36A811Medicare PIN
B13788Medicare UPIN
NY00525833Medicaid