Provider Demographics
NPI:1689635385
Name:PRICHEP, ROBERT N (PC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:N
Last Name:PRICHEP
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 SUNRISE HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-6019
Mailing Address - Country:US
Mailing Address - Phone:631-509-5460
Mailing Address - Fax:720-519-1848
Practice Address - Street 1:486 SUNRISE HWY STE 2
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-6019
Practice Address - Country:US
Practice Address - Phone:631-509-5460
Practice Address - Fax:720-519-1848
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148405208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00962092Medicaid
NY06E443Medicare PIN
NY00962092Medicaid
NYA100000813Medicare PIN