Provider Demographics
NPI:1689740854
Name:SHORT, ROBBY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBBY
Middle Name:
Last Name:SHORT
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 1:8012 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1901
Mailing Address - Country:US
Mailing Address - Phone:718-521-1056
Mailing Address - Fax:718-521-1104
Practice Address - Street 1:8012 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-1901
Practice Address - Country:US
Practice Address - Phone:718-521-1056
Practice Address - Fax:718-521-1104
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165927174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY63520AMedicare ID - Type Unspecified
NYE36728Medicare UPIN