Provider Demographics
NPI:1275547416
Name:BEHAN, ROBERT EDMUND (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDMUND
Last Name:BEHAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7902
Mailing Address - Country:US
Mailing Address - Phone:212-807-0019
Mailing Address - Fax:212-727-2395
Practice Address - Street 1:22 W 13TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7902
Practice Address - Country:US
Practice Address - Phone:212-807-0019
Practice Address - Fax:212-727-2395
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006641-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02458726Medicaid
NYC306C1Medicare ID - Type Unspecified
NYRB0C306C10Medicare PIN
NY02458726Medicaid
NYKS0WZZQX10Medicare PIN
NYC306CZZQX1Medicare PIN