Provider Demographics
NPI:1760423347
Name:IZQUIERDO, ROBERTO E (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:E
Last Name:IZQUIERDO
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 1:725 E. ADAMS STREET
Mailing Address - Street 2:5TH FL
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-464-5726
Mailing Address - Fax:315-464-2500
Practice Address - Street 1:725 E. ADAMS STREET
Practice Address - Street 2:5TH FL
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-464-5726
Practice Address - Fax:315-464-2500
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183878207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01480877Medicaid
NY01480877Medicaid
NYP460000982Medicare PIN