Provider Demographics
NPI:1073783270
Name:DR ROBERT T WOLTMAN DPM,PC
Entity Type:Organization
Organization Name:DR ROBERT T WOLTMAN DPM,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:WOLTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-823-6239
Mailing Address - Street 1:1488 METROPOLITAN AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-7446
Mailing Address - Country:US
Mailing Address - Phone:718-823-6239
Mailing Address - Fax:
Practice Address - Street 1:1488 METROPOLITAN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-7446
Practice Address - Country:US
Practice Address - Phone:718-823-6239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005360213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01789871Medicaid
NYU67558Medicare UPIN
NY01789871Medicaid
06875GMedicare PIN
NY06875Medicare PIN