Provider Demographics
NPI:1225035769
Name:BILLER, BOB S (DPM)
Entity Type:Individual
Prefix:DR
First Name:BOB
Middle Name:S
Last Name:BILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:756 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2605
Mailing Address - Country:US
Mailing Address - Phone:516-432-7470
Mailing Address - Fax:516-432-3479
Practice Address - Street 1:756 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2605
Practice Address - Country:US
Practice Address - Phone:516-432-7470
Practice Address - Fax:516-432-3479
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002835213E00000X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY397700Medicaid
NYP31961Medicare PIN
NY397700Medicaid
NYT50905Medicare UPIN