Healthcare Provider Details

I. General information

NPI: 1417241498
Provider Name (Legal Business Name): ETHAN RAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST BAKER 1600
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

525 E 68TH ST BAKER 1600
NEW YORK NY
10065-4870
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-1500
  • Fax:
Mailing address:
  • Phone: 212-746-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number280336
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: