Healthcare Provider Details

I. General information

NPI: 1073172565
Provider Name (Legal Business Name): ROBERT A KOWTONIUK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WASHINGTON RD
WEST POINT NY
10996-1109
US

IV. Provider business mailing address

900 WASHINGTON RD
WEST POINT NY
10996-1109
US

V. Phone/Fax

Practice location:
  • Phone: 845-938-6624
  • Fax:
Mailing address:
  • Phone: 845-938-6624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0102206434
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number1073172565
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102206434
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: