Provider Demographics
NPI:1174654487
Name:KORMENDI, ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:KORMENDI
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 1:14160 PERSHING CRESCENT
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1946
Mailing Address - Country:US
Mailing Address - Phone:718-523-4141
Mailing Address - Fax:718-297-2311
Practice Address - Street 1:8339 DANIELS ST
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-1208
Practice Address - Country:US
Practice Address - Phone:718-523-4141
Practice Address - Fax:718-297-2311
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206148208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01765833Medicaid
NY6013942OtherGHI COMMERCIAL
NY02347GMedicare PIN
NY66778CW461Medicare PIN