Healthcare Provider Details

I. General information

NPI: 1407805906
Provider Name (Legal Business Name): ROBERT THOMAS ABDERHALDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 MEADS CREEK RD
PAINTED POST NY
14870-9509
US

IV. Provider business mailing address

3805 MEADS CREEK RD
PAINTED POST NY
14870-9509
US

V. Phone/Fax

Practice location:
  • Phone: 607-962-3100
  • Fax:
Mailing address:
  • Phone: 607-962-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number146079
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number146079
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: