Healthcare Provider Details

I. General information

NPI: 1255473336
Provider Name (Legal Business Name): ROBERT A HESSON, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 DATES DRIVE SUITE 206
ITHACA NY
14850
US

IV. Provider business mailing address

202 TAUGHANNOCK BLVD. PO BOX 366
ITHACA NY
14850
US

V. Phone/Fax

Practice location:
  • Phone: 607-273-9111
  • Fax: 607-273-5580
Mailing address:
  • Phone: 607-277-3257
  • Fax: 607-277-4056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number159615
License Number StateNY

VIII. Authorized Official

Name: DR. ROBERT HESSON
Title or Position: OWNER
Credential: MD
Phone: 607-273-9111