Provider Demographics
NPI:1215965934
Name:RODGERS, I RAND (MD)
Entity type:Individual
Prefix:DR
First Name:I
Middle Name:RAND
Last Name:RODGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 E 79TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0866
Mailing Address - Country:US
Mailing Address - Phone:212-249-7600
Mailing Address - Fax:212-288-6545
Practice Address - Street 1:229 E 79TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0866
Practice Address - Country:US
Practice Address - Phone:212-249-7600
Practice Address - Fax:212-288-6545
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160366207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY66F67Medicare ID - Type Unspecified
NYA65022Medicare UPIN