Basic Information
Provider Information | |||||||||
NPI: | 1841287687 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HANSEN | ||||||||
FirstName: | ROBBIN | ||||||||
MiddleName: | H | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 25 E MAIN ST | ||||||||
Address2: |   | ||||||||
City: | SPRINGVILLE | ||||||||
State: | NY | ||||||||
PostalCode: | 141411244 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7165922832 | ||||||||
FaxNumber: | 7165924452 | ||||||||
Practice Location | |||||||||
Address1: | 25 E MAIN ST | ||||||||
Address2: |   | ||||||||
City: | SPRINGVILLE | ||||||||
State: | NY | ||||||||
PostalCode: | 141411244 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7165922832 | ||||||||
FaxNumber: | 7165924452 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/05/2005 | ||||||||
LastUpdateDate: | 09/02/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 169858 | NY | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
ID Information
ID | Type | State | Issuer | Description | 00010072704 | 01 | NY | UNIVERA | OTHER | 000510187010 | 01 | NY | BC/BS | OTHER | 040426000853 | 01 | NY | FIDELIS | OTHER | 146922DL | 01 | NY | PREFERRED CARE | OTHER | 01018524 | 05 | NY |   | MEDICAID | 1208950 | 01 | NY | IHA | OTHER |