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General NPI Number Information
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NPI Number | 1851618540
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Entity Type | Organization
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Legal Business Name | THE NITESURGEON PLLC
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Dates
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Enumeration Date | 04/21/2010
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Last Update Date | 12/31/2013
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Provider Practice Location Address
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Address Line | 21 LAUREL AVE SUITE 240
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City | CORNWALL
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State | NY
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Zip | 12518-1469
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Country | US
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Telephone | 845-534-0008
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Fax | 845-534-0018
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Provider Business Mailing Address
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Address Line | 21 LAUREL AVE SUITE 240
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City | CORNWALL
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State | NY
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Zip | 12518-1469
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Country | US
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Telephone | 845-534-0008
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Fax | 845-534-0018
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS V. ROBB
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Credential | DO
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Telephone | 845-534-0008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 209975
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License Number State | NY
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