Provider Demographics
NPI:1134143092
Name:SWIERUPSKI, ROBERT A (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:SWIERUPSKI
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 1:403 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-2205
Mailing Address - Country:US
Mailing Address - Phone:631-862-7062
Mailing Address - Fax:631-862-7114
Practice Address - Street 1:403 LAKE AVE
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-2205
Practice Address - Country:US
Practice Address - Phone:631-862-7062
Practice Address - Fax:631-862-7114
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312785207R00000X
MA223943207R00000X
AZ37974207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
93329OtherFALLON
AA34789OtherHPHC
MAJ28722OtherMABC
468248OtherTUFTS
000000030457OtherBMC HEALTHNET
MA2102641Medicaid
6594681OtherCIGNA
412722OtherRIBCHIP
MAJ28722OtherMABC
MAA38727Medicare ID - Type Unspecified