Provider Demographics
NPI:1467652792
Name:BARTOLI, ROBERT JR (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BARTOLI
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-0066
Mailing Address - Country:US
Mailing Address - Phone:516-609-2577
Mailing Address - Fax:
Practice Address - Street 1:1255 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-2515
Practice Address - Country:US
Practice Address - Phone:631-345-0073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021146174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ20A90W221Medicare PIN
NYQ42443Medicare UPIN