Provider Demographics
NPI:1346298197
Name:CONVERSANO, ROBIN J (RPA-C)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:J
Last Name:CONVERSANO
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Gender:F
Credentials:RPA-C
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Mailing Address - Street 1:290 E MAIN ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2916
Mailing Address - Country:US
Mailing Address - Phone:631-361-7867
Mailing Address - Fax:631-366-3290
Practice Address - Street 1:290 E MAIN ST
Practice Address - Street 2:SUITE 700
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2916
Practice Address - Country:US
Practice Address - Phone:631-361-7867
Practice Address - Fax:631-366-3290
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2019-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY006305363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4F9841Medicare ID - Type Unspecified
NYS62251Medicare UPIN
NY4F9842Medicare ID - Type Unspecified