Provider Demographics
NPI:1639428253
Name:RHETT, ROBERT
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:RHETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 E 24TH ST
Mailing Address - Street 2:538 EAST 24TH STREET
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-1130
Mailing Address - Country:US
Mailing Address - Phone:917-528-5558
Mailing Address - Fax:
Practice Address - Street 1:538 E 24TH ST
Practice Address - Street 2:538 EAST 24TH STREET
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-1130
Practice Address - Country:US
Practice Address - Phone:917-528-5558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY709174174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist