Provider Demographics
NPI:1861498123
Name:J G ROBILOTTI JR JR MD
Entity Type:Organization
Organization Name:J G ROBILOTTI JR JR MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROBILOTTI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:212-475-4030
Mailing Address - Street 1:29 WASHINGTON SQ W
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-9180
Mailing Address - Country:US
Mailing Address - Phone:212-475-4030
Mailing Address - Fax:
Practice Address - Street 1:29 WASHINGTON SQ W
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-9180
Practice Address - Country:US
Practice Address - Phone:212-475-4030
Practice Address - Fax:212-598-0562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY969951174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY581441Medicare PIN
NYB16908Medicare UPIN