Healthcare Provider Details

I. General information

NPI: 1588601793
Provider Name (Legal Business Name): ROBERT GARY JOSEPHBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 07/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

984 NORTH BROADWAY SUITE 511
YONKERS NY
10701-1308
US

IV. Provider business mailing address

11 TANGLEWOOD CIR
BRIARCLIFF MANOR NY
10510-2551
US

V. Phone/Fax

Practice location:
  • Phone: 914-965-2526
  • Fax: 914-965-2527
Mailing address:
  • Phone: 914-923-2392
  • Fax: 914-965-2527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number33921
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number134320
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number134320
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207WX0108X
TaxonomyUveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
License Number134320
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number134320
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: