Healthcare Provider Details

I. General information

NPI: 1427108588
Provider Name (Legal Business Name): ROBERT MAYO ISRAEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

942 FIFTH AVENUE GROUND FLOOR
NEW YORK NY
10021
US

IV. Provider business mailing address

942 FIFTH AVENUE GROUND FLOOR
NEW YORK NY
10021
US

V. Phone/Fax

Practice location:
  • Phone: 212-321-0071
  • Fax: 212-321-0074
Mailing address:
  • Phone: 212-321-0071
  • Fax: 212-321-0074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number114345
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: