Provider Demographics
NPI:1073698965
Name:LOPATIN, ROBERT JUDE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JUDE
Last Name:LOPATIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 672452
Mailing Address - Street 2:MOSHOLU STATION
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-0811
Mailing Address - Country:US
Mailing Address - Phone:718-432-2221
Mailing Address - Fax:718-432-2221
Practice Address - Street 1:735 KAPPOCK ST
Practice Address - Street 2:11D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4606
Practice Address - Country:US
Practice Address - Phone:718-432-2221
Practice Address - Fax:718-432-2221
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
NY224280207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02312494Medicaid
NY02312494Medicaid
NY113AQ1Medicare ID - Type Unspecified