Healthcare Provider Details

I. General information

NPI: 1609786912
Provider Name (Legal Business Name): ROBERT STEVEN DAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 DEKALB AVE
BROOKLYN NY
11201-5493
US

IV. Provider business mailing address

3236 JUDITH LN
OCEANSIDE NY
11572-4211
US

V. Phone/Fax

Practice location:
  • Phone: 718-250-8000
  • Fax:
Mailing address:
  • Phone: 718-250-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number613188
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: