Healthcare Provider Details

I. General information

NPI: 1477655017
Provider Name (Legal Business Name): ROBERTO ROBINSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 PLAZA ST E
BROOKLYN NY
11238-5040
US

IV. Provider business mailing address

3930 51ST ST
WOODSIDE NY
11377-3149
US

V. Phone/Fax

Practice location:
  • Phone: 718-783-3919
  • Fax:
Mailing address:
  • Phone: 917-674-2115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number236670
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number236670
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: