Provider Demographics
NPI:1609133685
Name:ROBERT, MIKE (LPN)
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:
Last Name:ROBERT
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 LINCOLN PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-4247
Mailing Address - Country:US
Mailing Address - Phone:646-549-0666
Mailing Address - Fax:
Practice Address - Street 1:745 LINCOLN PL APT 6D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-4245
Practice Address - Country:US
Practice Address - Phone:646-549-0666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308676-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse