Healthcare Provider Details

I. General information

NPI: 1992427736
Provider Name (Legal Business Name): JOHN ROBERTSON M D FAMILY MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

587 MAIN ST STE 104
NEW YORK MILLS NY
13417-1490
US

IV. Provider business mailing address

587 MAIN ST STE 104
NEW YORK MILLS NY
13417-1490
US

V. Phone/Fax

Practice location:
  • Phone: 315-732-9368
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN S ROBERTSON
Title or Position: OWNER
Credential: MD
Phone: 315-732-9368