Provider Demographics
NPI:1528039294
Name:LANTER, ROBERT B (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:LANTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MAIN ST
Mailing Address - Street 2:STE 4
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518
Mailing Address - Country:US
Mailing Address - Phone:516-766-5495
Mailing Address - Fax:516-766-3240
Practice Address - Street 1:131 MAIN ST
Practice Address - Street 2:STE 4
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518
Practice Address - Country:US
Practice Address - Phone:516-766-5495
Practice Address - Fax:516-766-3240
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY181556208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01609970Medicaid
F76093Medicare UPIN
NY01609970Medicaid
NY731751Medicare PIN