Provider Demographics
NPI:1669518262
Name:STORPER, IAN (MD)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:STORPER
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 1:110 E 59TH ST
Mailing Address - Street 2:SUITE 8C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1304
Mailing Address - Country:US
Mailing Address - Phone:212-434-4500
Mailing Address - Fax:212-434-4597
Practice Address - Street 1:110 E 59TH ST
Practice Address - Street 2:SUITE 8C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1304
Practice Address - Country:US
Practice Address - Phone:212-434-4500
Practice Address - Fax:212-434-4597
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198944174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01583146Medicaid