Healthcare Provider Details

I. General information

NPI: 1265420749
Provider Name (Legal Business Name): STEPHEN PETER RAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2270 KIMBALL ST STW 206
BROOKLYN NY
11234-5139
US

IV. Provider business mailing address

80 MARCUS DR PROVIDER ENROLLMENT
MELVILLE NY
11747-4230
US

V. Phone/Fax

Practice location:
  • Phone: 718-377-0011
  • Fax: 718-377-0011
Mailing address:
  • Phone: 631-391-7887
  • Fax: 631-454-4163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number114186
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number114186
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: