Provider Demographics
NPI:1548313828
Name:BROUMAND, STAFFORD R (MD)
Entity type:Individual
Prefix:DR
First Name:STAFFORD
Middle Name:R
Last Name:BROUMAND
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 1:75 EAST 71STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-879-7900
Mailing Address - Fax:718-672-4251
Practice Address - Street 1:75 EAST 71STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-879-7900
Practice Address - Fax:718-672-4251
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166718-1208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0100923OtherGHI
NYN37868OtherHEALTHNET
NYP3806444OtherOXFORD
NY80H671Medicare ID - Type Unspecified
NYP3806444OtherOXFORD