MEDICARE: DR. ROBERT GARY JOSEPHBERG MD

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	174400000X	Specialist	33921	NJ
2	174400000X	Specialist	134320	NY
3	207W00000X	Ophthalmology Physician	134320	NY
4	207WX0108X	Uveitis and Ocular Inflammatory Disease (Ophthalmology) Physician	134320	NY
5	207WX0107X	Retina Specialist (Ophthalmology) Physician	134320	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588601793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT GARY JOSEPHBERG MD

Provider Business Mailing Address
First Line	:	11 TANGLEWOOD CIR
Second Line	:
City	:	BRIARCLIFF MANOR
State	:	NY
Zip	:	10510-2551
Country	:	US
Telephone Number	:	914-923-2392
Fax Number	:	914-965-2527

Provider Business Practice Location Address
First Line	:	984 NORTH BROADWAY
Second Line	:	SUITE 511
City	:	YONKERS
State	:	NY
Zip	:	10701-1308
Country	:	US
Telephone Number	:	914-965-2526
Fax Number	:	914-965-2527

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	07/05/2017

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