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General NPI Number Information
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NPI Number | 1437435047
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Entity Type | Individual
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Provider Name | JUAN CARLOS ROBLES M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/26/2011
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Last Update Date | 07/27/2015
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Provider Practice Location Address
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Address Line | 1 FORDHAM PLZ 5TH FLOOR
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City | BRONX
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State | NY
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Zip | 10458-5871
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Country | US
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Telephone | 718-933-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 800 GRAND CONCOURSE APT 1BN
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City | BRONX
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State | NY
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Zip | 10451-3029
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Country | US
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Telephone | 917-696-3091
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 273239
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License Number State | NY
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