Provider Demographics
NPI:1245327162
Name:ROBB, THOMAS V (DO)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:V
Last Name:ROBB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LAUREL AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518
Mailing Address - Country:US
Mailing Address - Phone:845-534-0008
Mailing Address - Fax:845-534-0018
Practice Address - Street 1:21 LAUREL AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:CORNWALL
Practice Address - State:NY
Practice Address - Zip Code:12518
Practice Address - Country:US
Practice Address - Phone:845-534-0008
Practice Address - Fax:845-534-0018
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209975208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01818051Medicaid
NYA400083632Medicare PIN