Healthcare Provider Details

I. General information

NPI: 1568455533
Provider Name (Legal Business Name): ROBERT A KASLOVSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 NEW SCOTLAND AVE MC 88
ALBANY NY
12208-3412
US

IV. Provider business mailing address

47 NEW SCOTLAND AVE MC 88
ALBANY NY
12208-3412
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-6880
  • Fax: 518-262-6884
Mailing address:
  • Phone: 518-262-6880
  • Fax: 518-262-6884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number150449-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number238874
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: