Provider Demographics
NPI:1972174001
Name:KLOTZ, ROBERT (RN)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:KLOTZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-1210
Mailing Address - Country:US
Mailing Address - Phone:914-400-8764
Mailing Address - Fax:
Practice Address - Street 1:30 ROUTE 59
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:NY
Practice Address - Zip Code:10901
Practice Address - Country:US
Practice Address - Phone:845-357-0452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY737909163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse