Healthcare Provider Details

I. General information

NPI: 1215965934
Provider Name (Legal Business Name): I RAND RODGERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 E 79TH ST
NEW YORK NY
10021-0866
US

IV. Provider business mailing address

229 E 79TH ST
NEW YORK NY
10021-0866
US

V. Phone/Fax

Practice location:
  • Phone: 212-249-7600
  • Fax: 212-288-6545
Mailing address:
  • Phone: 212-249-7600
  • Fax: 212-288-6545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number160366
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: