Provider Demographics
NPI:1023021383
Name:TRAUT, ROBERT (CP)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:TRAUT
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 CORNWELL AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4732
Mailing Address - Country:US
Mailing Address - Phone:516-608-1885
Mailing Address - Fax:
Practice Address - Street 1:164B LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:ISLAND PARK
Practice Address - State:NY
Practice Address - Zip Code:11558-1512
Practice Address - Country:US
Practice Address - Phone:516-608-1885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCP0013621744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02915415Medicaid
NY5771640001Medicare NSC