Basic Information
Provider Information | |||||||||
NPI: | 1619338282 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | WINTHROP COMMUNITY MEDICAL AFFILIATES, PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | RICHARD ROBERTS, MD | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 700 HICKSVILLE RD | ||||||||
Address2: | 204 | ||||||||
City: | BETHPAGE | ||||||||
State: | NY | ||||||||
PostalCode: | 117143471 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5165766106 | ||||||||
FaxNumber: | 5165765801 | ||||||||
Practice Location | |||||||||
Address1: | 600 NORTHERN BLVD | ||||||||
Address2: | 106 | ||||||||
City: | GREAT NECK | ||||||||
State: | NY | ||||||||
PostalCode: | 110215206 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5164664128 | ||||||||
FaxNumber: | 5164821822 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/10/2016 | ||||||||
LastUpdateDate: | 03/10/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ADLER | ||||||||
AuthorizedOfficialFirstName: | MARC | ||||||||
AuthorizedOfficialMiddleName: | S | ||||||||
AuthorizedOfficialTitleorPosition: | CO-PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 5166633849 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
No ID Information.