Provider Demographics
NPI:1346320538
Name:WINCHELL, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:WINCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:525 E 68TH STREET
Mailing Address - Street 2:ROOM P7-714, BOX 116
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065
Mailing Address - Country:US
Mailing Address - Phone:646-962-8490
Mailing Address - Fax:212-746-8991
Practice Address - Street 1:525 E 68TH STREET
Practice Address - Street 2:STARR 8
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065
Practice Address - Country:US
Practice Address - Phone:646-962-8490
Practice Address - Fax:212-746-8991
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME015765208600000X
NY281064208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30203229Medicaid
ME335860099Medicaid
NH30203229Medicaid
MEMM898902Medicare PIN
MEMM8989Medicare PIN
ME335860099Medicaid
ME020049394Medicare PIN