Healthcare Provider Details

I. General information

NPI: 1093639445
Provider Name (Legal Business Name): ROBERT HENRY VON BARGEN CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 WILLIS AVE
ALBERTSON NY
11507-1230
US

IV. Provider business mailing address

1111 WILLIS AVE
ALBERTSON NY
11507-1230
US

V. Phone/Fax

Practice location:
  • Phone: 516-338-8585
  • Fax: 516-338-7575
Mailing address:
  • Phone: 516-338-8585
  • Fax: 516-338-7575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO4200
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO4200
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: