Provider Demographics
NPI:1144386863
Name:YODASHKIN, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:YODASHKIN
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 1:2905 S CONGRESS AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-7337
Mailing Address - Country:US
Mailing Address - Phone:561-243-2070
Mailing Address - Fax:561-243-2080
Practice Address - Street 1:2905 S CONGRESS AVE
Practice Address - Street 2:SUITE D
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-7337
Practice Address - Country:US
Practice Address - Phone:561-243-2070
Practice Address - Fax:561-243-2080
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133732207R00000X
FLME98252207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00350394Medicaid
NY01A691Medicare UPIN