Healthcare Provider Details

I. General information

NPI: 1609125624
Provider Name (Legal Business Name): ROBERT MORRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 FIELDS LN
PEEKSKILL NY
10566-4856
US

IV. Provider business mailing address

146 FIELDS LN
PEEKSKILL NY
10566-4856
US

V. Phone/Fax

Practice location:
  • Phone: 914-382-2592
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number014419
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number014419
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: