Provider Demographics
NPI:1578595351
Name:SCHLESSEL, ROBERT F BERKE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:F BERKE
Last Name:SCHLESSEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2 CHURCH ST. SOUTH
Mailing Address - Street 2:STE 504
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1717
Mailing Address - Country:US
Mailing Address - Phone:203-624-0006
Mailing Address - Fax:203-562-4694
Practice Address - Street 1:2 CHURCH ST S
Practice Address - Street 2:STE 504
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1717
Practice Address - Country:US
Practice Address - Phone:203-624-0006
Practice Address - Fax:203-562-4694
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT021634208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001216340Medicaid
CT020000453Medicare ID - Type Unspecified
CT001216340Medicaid
CTC65092Medicare UPIN
CT1578595351Medicare UPIN