Provider Demographics
NPI:1023092723
Name:TAYLOR, ROBERT J (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4 PALISADES DR
Mailing Address - Street 2:STE 200
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1443
Mailing Address - Country:US
Mailing Address - Phone:845-687-7455
Mailing Address - Fax:845-687-4685
Practice Address - Street 1:10 GAGNON DR
Practice Address - Street 2:
Practice Address - City:STONE RIDGE
Practice Address - State:NY
Practice Address - Zip Code:12484-5120
Practice Address - Country:US
Practice Address - Phone:845-687-7455
Practice Address - Fax:845-687-4685
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2016-05-31
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Provider Licenses
StateLicense IDTaxonomies
NY134973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00798678Medicaid
C05192Medicare UPIN
07D581Medicare PIN