Healthcare Provider Details

I. General information

NPI: 1164127767
Provider Name (Legal Business Name): FNU ROOBLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date: 11/06/2023
Reactivation Date: 11/21/2023

III. Provider practice location address

1042 MITCHELL AVE # 42
BINGHAMTON NY
13903-1678
US

IV. Provider business mailing address

10-42 MITCHELL AVE STE 1000
BINGHAMTON NY
13903-1617
US

V. Phone/Fax

Practice location:
  • Phone: 607-772-8772
  • Fax:
Mailing address:
  • Phone: 607-772-8772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMT228664
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: