Provider Demographics
NPI:1821142076
Name:FAY, ROBERT L (PT, MHSC,OCS,STC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:FAY
Suffix:
Gender:M
Credentials:PT, MHSC,OCS,STC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 PRIMROSE ST
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-3224
Mailing Address - Country:US
Mailing Address - Phone:914-232-0679
Mailing Address - Fax:
Practice Address - Street 1:475 MAIN ST
Practice Address - Street 2:
Practice Address - City:ARMONK
Practice Address - State:NY
Practice Address - Zip Code:10504-1840
Practice Address - Country:US
Practice Address - Phone:914-273-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0151452251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQJ0421Medicare ID - Type Unspecified