Healthcare Provider Details

I. General information

NPI: 1851304018
Provider Name (Legal Business Name): STEPHEN RAYPORT MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2146 JACKSON AVE
SEAFORD NY
11783-2606
US

IV. Provider business mailing address

2146 JACKSON AVE
SEAFORD NY
11783-2606
US

V. Phone/Fax

Practice location:
  • Phone: 516-622-8888
  • Fax: 516-785-0218
Mailing address:
  • Phone: 516-622-8888
  • Fax: 516-785-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number155946-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: