MEDICARE: DR. FADWA ROBB D.D.S

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	122300000X	Dentist	050653-1	NY

General Provider Information

NPI Number	:	1912248469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FADWA ROBB D.D.S

Provider Business Mailing Address
First Line	:	20 E 68TH ST
Second Line	:	SUITE 208
City	:	NEW YORK
State	:	NY
Zip	:	10065-5844
Country	:	US
Telephone Number	:	212-744-1333
Fax Number	:	212-734-8179

Provider Business Practice Location Address
First Line	:	20 E 68TH ST
Second Line	:	SUITE 208
City	:	NEW YORK
State	:	NY
Zip	:	10065-5844
Country	:	US
Telephone Number	:	212-744-1333
Fax Number	:	212-734-8179

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

Provider Enumeration Date	:	03/08/2013
Last Update Date	:	07/18/2019

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