Provider Demographics
NPI:1710913207
Name:ROBLES, GONZALO CARINO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GONZALO
Middle Name:CARINO
Last Name:ROBLES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ENGINEERS RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1008
Mailing Address - Country:US
Mailing Address - Phone:516-521-7040
Mailing Address - Fax:516-213-4778
Practice Address - Street 1:4 ENGINEERS RD
Practice Address - Street 2:
Practice Address - City:ROSLYN HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11576-1008
Practice Address - Country:US
Practice Address - Phone:516-521-7040
Practice Address - Fax:516-213-4778
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB58717Medicare UPIN
NY61419Medicare ID - Type UnspecifiedGHI-MEDICARE
NY110052300Medicare ID - Type UnspecifiedRAILROAD MEDICARE
NY723281Medicare ID - Type UnspecifiedEMPIRE MEDICARE SERVICES