MEDICARE: DR. EVAN G STEIN M.D., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	237410	NY

General Provider Information

NPI Number	:	1336323831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVAN G STEIN M.D., PH.D.

Provider Business Mailing Address
First Line	:	333 E 30TH ST
Second Line	:	APT. 6M
City	:	NEW YORK
State	:	NY
Zip	:	10016-6416
Country	:	US
Telephone Number	:	212-779-0829
Fax Number	:

Provider Business Practice Location Address
First Line	:	4805 FORT HAMILTON PKWY
Second Line	:	DEPARTMENT OF RADIOLOGY
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2937
Country	:	US
Telephone Number	:	718-283-7199
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2007
Last Update Date	:	05/06/2015

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