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General NPI Number Information
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NPI Number | 1518049782
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Entity Type | Individual
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Provider Name | RANDALL P OWEN MD
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Gender | Male
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 01/07/2010
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Provider Practice Location Address
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Address Line | 5 E 98TH ST, # 1259 MOUNT SINAI MEDICAL CENTER--FACULTY PRACTICE ASSOCIATES
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City | NEW YORK
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State | NY
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Zip | 10029-6574
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Country | US
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Telephone | 212-241-1657
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Fax | 212-202-4703
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Provider Business Mailing Address
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Address Line | 530 E 84TH ST APT 2-S
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City | NEW YORK
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State | NY
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Zip | 10028-7319
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Country | US
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Telephone | 212-241-1657
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Fax | 212-202-4703
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 202892
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License Number State | NY
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