Provider Demographics
NPI:1790705945
Name:POTENZA, ROBERT M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:POTENZA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2800 BRUCKNER BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-4500
Mailing Address - Country:US
Mailing Address - Phone:718-597-9595
Mailing Address - Fax:718-597-2807
Practice Address - Street 1:2800 BRUCKNER BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1907
Practice Address - Country:US
Practice Address - Phone:718-597-9595
Practice Address - Fax:718-597-2807
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2020-10-27
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Provider Licenses
StateLicense IDTaxonomies
NY096993207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB19091Medicare UPIN