Provider Demographics
NPI:1497828107
Name:CONENELLO, ROBERT MICHAEL (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:CONENELLO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DUTCH HILL RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-2197
Mailing Address - Country:US
Mailing Address - Phone:845-365-3100
Mailing Address - Fax:845-365-3253
Practice Address - Street 1:100 DUTCH HILL RD
Practice Address - Street 2:SUITE 270
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-2197
Practice Address - Country:US
Practice Address - Phone:845-365-3100
Practice Address - Fax:845-365-3253
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004796-1213ES0131X
NJMD02083213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01234399Medicaid
NYRS294OtherOXFORD
NY4628693OtherAETNA
NYU12240Medicare UPIN
NJ167881Medicare PIN
NY01234399Medicaid
NYP53581Medicare ID - Type Unspecified