MEDICARE: DR. ROBERT FUENTES M.D.

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
1	207R00000X	Internal Medicine Physician	141462	NY
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	141462	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376624288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT FUENTES M.D.

Provider Business Mailing Address
First Line	:	4277 HEMPSTEAD TPKE
Second Line	:
City	:	BETHPAGE
State	:	NY
Zip	:	11714-5709
Country	:	US
Telephone Number	:	516-731-7770
Fax Number	:	516-731-7052

Provider Business Practice Location Address
First Line	:	4150 SUNRISE HWY
Second Line	:
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-5303
Country	:	US
Telephone Number	:	516-541-1721
Fax Number	:	516-541-1463

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	09/11/2025

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