Healthcare Provider Details

I. General information

NPI: 1326846486
Provider Name (Legal Business Name): ROBERT BUMBY LSM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E CENTRAL AVE
PEARL RIVER NY
10965-2543
US

IV. Provider business mailing address

125 E CENTRAL AVE
PEARL RIVER NY
10965-2543
US

V. Phone/Fax

Practice location:
  • Phone: 845-652-3170
  • Fax:
Mailing address:
  • Phone: 845-652-3170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number01288901
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: