Provider Demographics
NPI:1407896319
Name:MEDITZ, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MEDITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4802 TENTH AVENUE
Mailing Address - Street 2:ATTN CARDIOLOGY
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2916
Mailing Address - Country:US
Mailing Address - Phone:718-283-7489
Mailing Address - Fax:718-283-8956
Practice Address - Street 1:4802 TENTH AVENUE
Practice Address - Street 2:ATTN CARDIOLOGY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2916
Practice Address - Country:US
Practice Address - Phone:718-283-7489
Practice Address - Fax:718-283-8956
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1608201207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01045692Medicaid
A60447Medicare UPIN
NY01045692Medicaid