MEDICARE: ROBERT F DIBARO RPA-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
1	363AM0700X	Medical Physician Assistant	012614	NY

General Provider Information

NPI Number	:	1376707505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT F DIBARO RPA-C

Provider Business Mailing Address
First Line	:	2426 ARON DR N
Second Line	:
City	:	SEAFORD
State	:	NY
Zip	:	11783-3520
Country	:	US
Telephone Number	:	516-982-5791
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 FULTON ST STE 1
Second Line	:
City	:	FARMINGDALE
State	:	NY
Zip	:	11735-3601
Country	:	US
Telephone Number	:	516-845-1600
Fax Number	:	515-845-5610

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

Provider Enumeration Date	:	07/16/2008
Last Update Date	:	01/25/2022

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