Provider Demographics
NPI:1063447746
Name:DWECK, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:DWECK
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 1:1037 MAIN ST
Mailing Address - Street 2:4TH FLOOR - CREDENTIALING
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2913
Mailing Address - Country:US
Mailing Address - Phone:914-734-8858
Mailing Address - Fax:914-734-8745
Practice Address - Street 1:3360 ROUTE 343
Practice Address - Street 2:HUDSON RIVER HEALTHCARE, INC.
Practice Address - City:AMENIA
Practice Address - State:NY
Practice Address - Zip Code:12501
Practice Address - Country:US
Practice Address - Phone:845-373-9006
Practice Address - Fax:845-373-7021
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00921426Medicaid
NY56D251Medicare ID - Type Unspecified
NYA63281Medicare UPIN
A400051244Medicare PIN