Healthcare Provider Details

I. General information

NPI: 1790971299
Provider Name (Legal Business Name): WILLIAM J. ROBBINS, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MEADOW DR
STONY BROOK NY
11790-2810
US

IV. Provider business mailing address

4 MEADOW DR
STONY BROOK NY
11790-2810
US

V. Phone/Fax

Practice location:
  • Phone: 631-741-4323
  • Fax: 631-751-6488
Mailing address:
  • Phone: 631-741-4323
  • Fax: 631-751-6488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number162576
License Number StateNY

VIII. Authorized Official

Name: DR. WILLIAM JAMES ROBBINS
Title or Position: OWNER
Credential: M.D.
Phone: 631-741-4323