Healthcare Provider Details

I. General information

NPI: 1437136892
Provider Name (Legal Business Name): ROBERT GENDLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GRAND ST
NEW BRITAIN CT
06052-2016
US

IV. Provider business mailing address

1 LIBERTY SQ PO BOX 217
NEW BRITAIN CT
06050-0217
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-5556
  • Fax:
Mailing address:
  • Phone: 860-827-0071
  • Fax: 860-229-5642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number032738
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number032738
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: