Healthcare Provider Details

I. General information

NPI: 1629143722
Provider Name (Legal Business Name): ROBBIN FRIEDBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ROUTE 25A
SMITHTOWN NY
11787-1348
US

IV. Provider business mailing address

PO BOX 6010
HAUPPAUGE NY
11788-9010
US

V. Phone/Fax

Practice location:
  • Phone: 631-862-3222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number302437
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: