=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962719310
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT I RATTINER MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2010
-----------------------------------------------------
Last Update Date | 06/23/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 99 HILLSIDE AVENUE SUITE T
-----------------------------------------------------
City | WILLISTON PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-498-1965
-----------------------------------------------------
Fax | 516-504-0235
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 99 HILLSIDE AVENUE SUITE T
-----------------------------------------------------
City | WILLISTON PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-498-1965
-----------------------------------------------------
Fax | 516-504-0235
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT & CEO
-----------------------------------------------------
Name | ROBERT I RATTINER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 516-498-1965
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 194753
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------