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General NPI Number Information
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NPI Number | 1881667905
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Entity Type | Individual
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Provider Name | IVAN PAUL RAPPAPORT M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 09/21/2018
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Provider Practice Location Address
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Address Line | 414 MAPLE AVE
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-5550
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Country | US
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Telephone | 518-587-9243
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Fax | 518-587-6836
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Provider Business Mailing Address
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Address Line | 414 MAPLE AVE SUITE 300
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-5550
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Country | US
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Telephone | 518-587-9243
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Fax | 518-587-6836
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 160824
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License Number State | NY
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