Provider Demographics
NPI:1760442412
Name:BURCHMAN, ROBYN JO (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBYN
Middle Name:JO
Last Name:BURCHMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3836 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2435
Mailing Address - Country:US
Mailing Address - Phone:718-892-2035
Mailing Address - Fax:718-892-2152
Practice Address - Street 1:3836 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2435
Practice Address - Country:US
Practice Address - Phone:718-892-2035
Practice Address - Fax:718-892-2152
Is Sole Proprietor?:No
Enumeration Date:2006-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040506-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01392727Medicaid