Healthcare Provider Details

I. General information

NPI: 1568530129
Provider Name (Legal Business Name): ROBERT KLUGMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 COLGATE DRIVE
PLAINVIEW NY
11803
US

IV. Provider business mailing address

62 COLGATE DRIVE
PLAINVIEW NY
11803
US

V. Phone/Fax

Practice location:
  • Phone: 516-367-4315
  • Fax: 516-692-4968
Mailing address:
  • Phone: 516-367-4315
  • Fax: 516-692-4968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number164021
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number164021
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: