Healthcare Provider Details

I. General information

NPI: 1942334412
Provider Name (Legal Business Name): ROBROY PUETZ RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 ON THE PLAZA
MONTAUK NY
11954-7407
US

IV. Provider business mailing address

64 EAST ST
FLANDERS NY
11901-4204
US

V. Phone/Fax

Practice location:
  • Phone: 203-507-9302
  • Fax:
Mailing address:
  • Phone: 631-668-2994
  • Fax: 631-668-1109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number15527
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: