Provider Demographics
NPI:1316208002
Name:PICKELS, ROBERT FIRTH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FIRTH
Last Name:PICKELS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:FIRTH
Other - Last Name:PICKELS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4621 E SENECA ST
Mailing Address - Street 2:
Mailing Address - City:SHERRILL
Mailing Address - State:NY
Mailing Address - Zip Code:13461-1025
Mailing Address - Country:US
Mailing Address - Phone:315-363-2046
Mailing Address - Fax:
Practice Address - Street 1:267 HILL ROAD
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13441
Practice Address - Country:US
Practice Address - Phone:315-338-7540
Practice Address - Fax:315-338-7538
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106450-1208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery