MEDICARE: CONRAD CEAN M.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	174400000X	Specialist	225389	NY
2	207L00000X	Anesthesiology Physician	225389	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659377661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONRAD CEAN M.D.

Provider Business Mailing Address
First Line	:	1400 5TH AVENUE
Second Line	:	SUITE 3E
City	:	NEW YORK
State	:	NY
Zip	:	10026
Country	:	US
Telephone Number	:	888-789-6672
Fax Number	:	646-862-9066

Provider Business Practice Location Address
First Line	:	1400 5TH AVE
Second Line	:	SUITE 3E
City	:	NEW YORK
State	:	NY
Zip	:	10026-2584
Country	:	US
Telephone Number	:	888-789-6672
Fax Number	:	646-862-9066

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	04/28/2011

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