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General NPI Number Information
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NPI Number | 1700979887
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Entity Type | Individual
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Provider Name | ROBERT L WIGHTON MD
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10201 66TH RD
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City | FOREST HILLS
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State | NY
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Zip | 11375-2029
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Country | US
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Telephone | 800-376-5566
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 30230
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City | HARTFORD
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State | CT
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Zip | 06150-0230
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Country | US
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Telephone | 800-376-5566
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 170716-1
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License Number State | NY
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Legacy Identifiers
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Identifier #1
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Identifier Code | 01055063
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Identifier Type | MEDICAID
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Identifier State | NY
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Identifier Issuer |
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 01055063
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Identifier Type | MEDICAID
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Identifier State | NY
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Identifier Issuer |
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