Healthcare Provider Details

I. General information

NPI: 1922007772
Provider Name (Legal Business Name): ROBERT GEORGE PHELPS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 12/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL 3-08 ANNENBERG BUILDING
NEW YORK NY
10029-6500
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL PATHOLOGY, BOX 1194
NEW YORK NY
10029-6500
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6064
  • Fax: 212-241-7832
Mailing address:
  • Phone: 212-731-7772
  • Fax: 212-534-7491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number152938
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number152938
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: