Provider Demographics
NPI:1013249366
Name:ADDON, ROBERT MICHAEL (ATC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:ADDON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 RICHARD CT
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2305
Mailing Address - Country:US
Mailing Address - Phone:201-906-1545
Mailing Address - Fax:
Practice Address - Street 1:49 VIOLA RD
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-3228
Practice Address - Country:US
Practice Address - Phone:845-590-3829
Practice Address - Fax:845-357-4947
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001178390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program