Healthcare Provider Details

I. General information

NPI: 1992635239
Provider Name (Legal Business Name): CHRISTOPHER ROBACK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E STATE ST
HERKIMER NY
13350-2335
US

IV. Provider business mailing address

2502 ALBANY RD
FRANKFORT NY
13340-4334
US

V. Phone/Fax

Practice location:
  • Phone: 315-619-3034
  • Fax:
Mailing address:
  • Phone: 315-982-3559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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: