Healthcare Provider Details

I. General information

NPI: 1003037771
Provider Name (Legal Business Name): ROBERT MICHAEL LEMBO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 1ST AVE
NEW YORK NY
10016-9196
US

IV. Provider business mailing address

PO BOX 330
MADISON CT
06443-0330
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-6425
  • Fax:
Mailing address:
  • Phone: 203-245-2869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number182033
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: