=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427506021
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEWEY ROBBIANO JR. MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2016
-----------------------------------------------------
Last Update Date | 09/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3333 NE 34TH ST APT 1210 APT 1210
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33308-6915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-564-0654
-----------------------------------------------------
Fax | 123-456-7890
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3333 NE 34TH ST APT 1210 APT 1210
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33308-6915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-564-0654
-----------------------------------------------------
Fax | 123-456-7890
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 076666-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------