Provider Demographics
NPI:1639198294
Name:NOBERT, CRAIG F (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:F
Last Name:NOBERT
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 1:425 W 59TH ST
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1104
Mailing Address - Country:US
Mailing Address - Phone:212-523-8401
Mailing Address - Fax:212-523-8317
Practice Address - Street 1:425 W 59TH ST
Practice Address - Street 2:SUITE 3A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1104
Practice Address - Country:US
Practice Address - Phone:212-523-8401
Practice Address - Fax:212-523-8317
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219503174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02602413Medicaid
NY37R521Medicare ID - Type Unspecified
NYI2074BMedicare UPIN