Provider Demographics
NPI:1861460859
Name:DESNICK, ROBERT J (PHD, MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:DESNICK
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Gender:M
Credentials:PHD, MD
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Mailing Address - Street 1:1 GUSTAVE L LEVY PL
Mailing Address - Street 2:BOX 1498
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6500
Mailing Address - Country:US
Mailing Address - Phone:212-659-6700
Mailing Address - Fax:212-360-1809
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:BOX 1498
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6500
Practice Address - Country:US
Practice Address - Phone:212-659-6700
Practice Address - Fax:212-360-1809
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2019-03-22
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Provider Licenses
StateLicense IDTaxonomies
NY130912207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB13009Medicare UPIN