Provider Demographics
NPI:1306938378
Name:PHILLIPS, ROBIN NUSSBAUM (MD)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:NUSSBAUM
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 EAST 88TH STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:212-534-5300
Mailing Address - Fax:212-860-4891
Practice Address - Street 1:62 EAST 88TH STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128
Practice Address - Country:US
Practice Address - Phone:212-534-5300
Practice Address - Fax:212-860-4891
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY140328207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
75A881Medicare ID - Type Unspecified
B79271Medicare UPIN