Provider Demographics
NPI:1851388862
Name:LYNN, ROBERT I (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:I
Last Name:LYNN
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 1:2452 BRONX PARK E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-7503
Mailing Address - Country:US
Mailing Address - Phone:718-655-4956
Mailing Address - Fax:718-652-8058
Practice Address - Street 1:1200 WATERS PL
Practice Address - Street 2:SUITE M104
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2728
Practice Address - Country:US
Practice Address - Phone:718-794-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125759207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00410682Medicaid
A64866Medicare UPIN
NY93A882Medicare ID - Type Unspecified