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NPI Code Detail

MEDICARE: ROBERT K. ANSBACH R.P.A.-C

MEDICARE: ROBERT K. ANSBACH R.P.A.-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant002712-1NY

General Provider Information

NPI Number : 1326041260
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT K. ANSBACH R.P.A.-C
Provider Business Mailing Address
First Line : 11 GRADUATE CT
Second Line :
City : EAST SETAUKET
State : NY
Zip : 11733-1079
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : STONY BROOK UNIVERSITY STUDENT HEALTH SERVICE
Second Line :
City : STONY BROOK
State : NY
Zip : 11794-0001
Country : US
Telephone Number : 631-632-6740
Fax Number : 631-632-6936
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 07/08/2007

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