Provider Demographics
NPI:1326288978
Name:DR ROBERT N PRICHEP PHYSICIAN PC
Entity Type:Organization
Organization Name:DR ROBERT N PRICHEP PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:G
Authorized Official - Last Name:CELMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-737-4168
Mailing Address - Street 1:286 SILLS RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-8810
Mailing Address - Country:US
Mailing Address - Phone:631-654-9090
Mailing Address - Fax:631-654-0265
Practice Address - Street 1:286 SILLS RD
Practice Address - Street 2:SUITE 5
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-8810
Practice Address - Country:US
Practice Address - Phone:631-654-9090
Practice Address - Fax:631-654-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148405208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00962092Medicaid
NYA100000813Medicare PIN
NYA60236Medicare UPIN
NY06E443Medicare PIN