Provider Demographics
NPI:1083712772
Name:FATH, ROBERT B JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:FATH
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:550 MAMARONECK AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-1634
Mailing Address - Country:US
Mailing Address - Phone:914-723-8100
Mailing Address - Fax:914-219-1928
Practice Address - Street 1:259 HEATHCOTE RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4523
Practice Address - Country:US
Practice Address - Phone:914-723-8100
Practice Address - Fax:914-219-1928
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-02-10
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Provider Licenses
StateLicense IDTaxonomies
NY139040207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11092405OtherMEDICARE RAILROAD
NY487207OtherUNITED HEALTH CARE
NY137403OtherONE HEALTH PLAN
NYWP484OtherOXFORD HEALTH PLANS
NY00767097Medicaid
NYWP484OtherOXFORD HEALTH PLANS
NYB20223Medicare UPIN