Provider Demographics
NPI:1265420749
Name:RAND, STEPHEN PETER (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PETER
Last Name:RAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:80 MARCUS DR
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4230
Mailing Address - Country:US
Mailing Address - Phone:631-391-7887
Mailing Address - Fax:631-454-4163
Practice Address - Street 1:2270 KIMBALL ST
Practice Address - Street 2:STW 206
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5139
Practice Address - Country:US
Practice Address - Phone:718-377-0011
Practice Address - Fax:718-377-0011
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2013-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY114186207K00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP452722OtherOXFORD
NY00430924Medicaid
NYP452722OtherOXFORD
NY22A412Medicare PIN