Provider Demographics
NPI:1184683633
Name:KAYLAKOV, ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:KAYLAKOV
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 1:280 TIMBER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-6124
Mailing Address - Country:US
Mailing Address - Phone:347-603-5647
Mailing Address - Fax:347-695-1117
Practice Address - Street 1:1 BROOKDALE PLAZA
Practice Address - Street 2:BROOKDALE HOSPITAL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212
Practice Address - Country:US
Practice Address - Phone:718-240-6126
Practice Address - Fax:718-240-6550
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237646208100000X
NY237464-1208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02706898Medicaid
NY237464OtherLICENSE
NY02706898Medicaid
NY0105WGMedicare Oscar/Certification
NY237464OtherLICENSE
NY146451Medicare PIN