Healthcare Provider Details

I. General information

NPI: 1891124566
Provider Name (Legal Business Name): ROBERT DEUTCH D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 11/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 E 54TH ST 31
NEW YORK NY
10022-4211
US

IV. Provider business mailing address

59 E 54TH ST 31
NEW YORK NY
10022-4211
US

V. Phone/Fax

Practice location:
  • Phone: 212-753-9860
  • Fax:
Mailing address:
  • Phone: 212-753-9860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number037262
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: