Provider Demographics
NPI:1578614343
Name:DITKOFF, ROBERT ROY (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ROY
Last Name:DITKOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 PARK AVENUE
Mailing Address - Street 2:SUITE1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4255
Mailing Address - Country:US
Mailing Address - Phone:212-772-2800
Mailing Address - Fax:212-772-9220
Practice Address - Street 1:755 PARK AVENUE
Practice Address - Street 2:SUITE1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4255
Practice Address - Country:US
Practice Address - Phone:212-772-2800
Practice Address - Fax:212-772-9220
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122358174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00480117Medicaid
17A141Medicare PIN
NYB09873Medicare UPIN
NY30876GMedicare PIN
NY17A141Medicare PIN
B09873Medicare UPIN