Provider Demographics
NPI:1164400792
Name:KRESCH, ROBERT ALAN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
Last Name:KRESCH
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 1:283 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07648-1604
Mailing Address - Country:US
Mailing Address - Phone:201-768-5773
Mailing Address - Fax:
Practice Address - Street 1:115 DREISER LOOP
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-2701
Practice Address - Country:US
Practice Address - Phone:718-320-6300
Practice Address - Fax:718-379-1688
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162557207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA62841Medicare UPIN
NY45D911Medicare ID - Type Unspecified