Provider Demographics
NPI:1275592933
Name:SNYDER, ROBERT S (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:SNYDER
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 1:3594 E TREMONT AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2032
Mailing Address - Country:US
Mailing Address - Phone:718-792-8790
Mailing Address - Fax:718-904-8685
Practice Address - Street 1:3594 E TREMONT AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2032
Practice Address - Country:US
Practice Address - Phone:718-792-8790
Practice Address - Fax:718-904-8685
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003289213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY689592-7Medicaid
NYP35222Medicare PIN
NYT51045Medicare UPIN
NY1315380001Medicare NSC
NY689592-7Medicaid
NY6453940001Medicare NSC
NY1315380002Medicare NSC