MEDICARE: ROBERT VAISELBERG PA

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	363A00000X	Physician Assistant	011173	NY

General Provider Information

NPI Number	:	1568551836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT VAISELBERG PA

Provider Business Mailing Address
First Line	:	5115 15TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-6694
Country	:	US
Telephone Number	:	718-686-2030
Fax Number	:	718-741-7162

Provider Business Practice Location Address
First Line	:	5115 15TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-6694
Country	:	US
Telephone Number	:	718-686-2030
Fax Number	:	718-741-7162

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	10/29/2025

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