Healthcare Provider Details

I. General information

NPI: 1316233141
Provider Name (Legal Business Name): JUAN ANTONIO ROBLES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL
NEW YORK NY
10029-6504
US

IV. Provider business mailing address

1176 5TH AVE # KP9
NEW YORK NY
10029-6503
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6500
  • Fax:
Mailing address:
  • Phone: 212-241-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number313891
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number125059859
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: