Provider Demographics
NPI:1942548599
Name:KALISH, ROBERT IRA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:IRA
Last Name:KALISH
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 1:57 WARREN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-1018
Mailing Address - Country:US
Mailing Address - Phone:212-791-2898
Mailing Address - Fax:
Practice Address - Street 1:57 WARREN ST APT 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1018
Practice Address - Country:US
Practice Address - Phone:212-791-2898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142527291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory