Provider Demographics
NPI:1922058072
Name:SCHRAGER, RANDALL E (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:E
Last Name:SCHRAGER
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 1:226 N BELLE MEAD RD
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3458
Mailing Address - Country:US
Mailing Address - Phone:631-706-0018
Mailing Address - Fax:631-706-0024
Practice Address - Street 1:226 N BELLE MEAD RD STE C
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3524
Practice Address - Country:US
Practice Address - Phone:631-706-0018
Practice Address - Fax:631-706-0023
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191065208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12L6185891Medicare PIN
NYF47651Medicare UPIN