Healthcare Provider Details

I. General information

NPI: 1801863295
Provider Name (Legal Business Name): RICHARD LAWRENCE STAPEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 MERRICK RD
MASSAPEQUA NY
11758-6000
US

IV. Provider business mailing address

4160 MERRICK RD
MASSAPEQUA NY
11758-6000
US

V. Phone/Fax

Practice location:
  • Phone: 516-797-6700
  • Fax: 516-797-8463
Mailing address:
  • Phone: 516-797-6700
  • Fax: 516-797-8463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number131211
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: