Provider Demographics
NPI:1750473559
Name:PALTZIK, ROBERT L (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:PALTZIK
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 1:2 HILLSIDE AVE STE G
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-2335
Mailing Address - Country:US
Mailing Address - Phone:516-747-2230
Mailing Address - Fax:516-747-1087
Practice Address - Street 1:2 HILLSIDE AVE STE G
Practice Address - Street 2:
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-2335
Practice Address - Country:US
Practice Address - Phone:516-747-2230
Practice Address - Fax:516-747-1087
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122707-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB12797Medicare UPIN
NY315361Medicare ID - Type Unspecified