Provider Demographics
NPI:1033384359
Name:ISRAEL, ROBERT JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:ISRAEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 6TH AVE
Mailing Address - Street 2:SUITE 1801
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2514
Mailing Address - Country:US
Mailing Address - Phone:212-755-5854
Mailing Address - Fax:212-758-0997
Practice Address - Street 1:1414 6TH AVE
Practice Address - Street 2:SUITE 1801
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2514
Practice Address - Country:US
Practice Address - Phone:212-755-5854
Practice Address - Fax:212-758-0997
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0386671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice