Provider Demographics
NPI:1730282104
Name:FABRIZIO, ROBERT D (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:FABRIZIO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 ATLANTIC AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4265
Mailing Address - Country:US
Mailing Address - Phone:516-379-4440
Mailing Address - Fax:516-379-5187
Practice Address - Street 1:960 ATLANTIC AVE STE 2
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4265
Practice Address - Country:US
Practice Address - Phone:516-379-4440
Practice Address - Fax:516-379-5187
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX3417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T52422Medicare UPIN
NYX18951Medicare ID - Type Unspecified