Provider Demographics
NPI:1114039195
Name:BULLOCK, ROBERT M
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:BULLOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7535 210TH ST
Mailing Address - Street 2:APT 4D
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3252
Mailing Address - Country:US
Mailing Address - Phone:718-598-9799
Mailing Address - Fax:
Practice Address - Street 1:7535 210TH ST
Practice Address - Street 2:APT 4D
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-3252
Practice Address - Country:US
Practice Address - Phone:718-598-9799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000010879237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist