Provider Demographics
NPI:1881824811
Name:ROBERT A. IRWIN, DPM, PC
Entity Type:Organization
Organization Name:ROBERT A. IRWIN, DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:IRWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-623-2800
Mailing Address - Street 1:143 MERRICK AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3414
Mailing Address - Country:US
Mailing Address - Phone:516-623-2800
Mailing Address - Fax:516-623-7115
Practice Address - Street 1:143 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3414
Practice Address - Country:US
Practice Address - Phone:516-623-2800
Practice Address - Fax:516-623-7115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-24
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005279213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6317660001Medicare NSC