Provider Demographics
NPI:1043202070
Name:QUIMBY, ROBERT R (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:QUIMBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-1311
Mailing Address - Country:US
Mailing Address - Phone:518-475-9235
Mailing Address - Fax:518-475-9406
Practice Address - Street 1:190 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1311
Practice Address - Country:US
Practice Address - Phone:518-475-9235
Practice Address - Fax:518-475-9406
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166224207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01159966Medicaid
NYE28158Medicare UPIN
NYRA2967Medicare PIN