Provider Demographics
NPI:1942300439
Name:KUISIS, ROBERT (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:KUISIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2065
Mailing Address - Street 2:128 BRIDGEHAMPTON-SAG HARBOR TURNPIKE
Mailing Address - City:BRIDGEHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11932-2065
Mailing Address - Country:US
Mailing Address - Phone:631-907-0539
Mailing Address - Fax:
Practice Address - Street 1:128 BRIDGEHAMPTON-SAG HARBOR TURNPIKE
Practice Address - Street 2:OFFICE C
Practice Address - City:BRIDGEHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11932-2065
Practice Address - Country:US
Practice Address - Phone:631-907-0549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8418103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV67041Medicare ID - Type Unspecified
NYV67042Medicare ID - Type Unspecified