=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093835282
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT WILLIAM MOTTA PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2007
-----------------------------------------------------
Last Update Date | 02/15/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 233 SEVENTH STREET, SUITE #12
-----------------------------------------------------
City | GARDEN CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-885-9182
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 230 HILTON AVE STE 218
-----------------------------------------------------
City | HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11550-8116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-565-2266
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 005072
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------