Healthcare Provider Details

I. General information

NPI: 1962503003
Provider Name (Legal Business Name): ROBERT ENGEL D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1398 VICTORY BLVD
STATEN ISLAND NY
10301-3908
US

IV. Provider business mailing address

1398 VICTORY BLVD
STATEN ISLAND NY
10301-3908
US

V. Phone/Fax

Practice location:
  • Phone: 718-981-4515
  • Fax:
Mailing address:
  • Phone: 718-981-4515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number003008
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: