Provider Demographics
NPI:1982683041
Name:FAFALAK, ROBERT G (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:FAFALAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:36 WEST 9TH ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011
Mailing Address - Country:US
Mailing Address - Phone:917-364-9398
Mailing Address - Fax:212-452-1981
Practice Address - Street 1:4 LEXINGTON AVE
Practice Address - Street 2:1S
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5416
Practice Address - Country:US
Practice Address - Phone:212-533-2760
Practice Address - Fax:212-387-9143
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2012-03-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY175702207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01194027Medicaid
NY01194027Medicaid
NY52F391Medicare ID - Type Unspecified