Provider Demographics
NPI:1568500981
Name:WAX, ROBYN JILL (CSW)
Entity Type:Individual
Prefix:MRS
First Name:ROBYN
Middle Name:JILL
Last Name:WAX
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 RODEO DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-2210
Mailing Address - Country:US
Mailing Address - Phone:516-426-9598
Mailing Address - Fax:516-364-0314
Practice Address - Street 1:70 RODEO DR
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-2210
Practice Address - Country:US
Practice Address - Phone:516-426-9598
Practice Address - Fax:516-364-0314
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021935-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor