Healthcare Provider Details

I. General information

NPI: 1285791178
Provider Name (Legal Business Name): ROBERT ANTONIO DA SILVA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BROADWAY FL 2
NEW YORK NY
10006-1995
US

IV. Provider business mailing address

111 BROADWAY FL 2
NEW YORK NY
10006-1995
US

V. Phone/Fax

Practice location:
  • Phone: 646-461-2544
  • Fax:
Mailing address:
  • Phone: 646-461-2544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number217859
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number217859
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: