Healthcare Provider Details

I. General information

NPI: 1023021383
Provider Name (Legal Business Name): ROBERT TRAUT C.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164B LONG BEACH RD
ISLAND PARK NY
11558-1512
US

IV. Provider business mailing address

1141 CORNWELL AVE
BALDWIN NY
11510-4732
US

V. Phone/Fax

Practice location:
  • Phone: 516-608-1885
  • Fax:
Mailing address:
  • Phone: 516-608-1885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberCP001362
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: