Provider Demographics
NPI:1245449305
Name:ROBERT I. ADLER, M.D.,P.C.
Entity type:Organization
Organization Name:ROBERT I. ADLER, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-561-8820
Mailing Address - Street 1:210 CORNELIA ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2318
Mailing Address - Country:US
Mailing Address - Phone:518-561-8820
Mailing Address - Fax:
Practice Address - Street 1:210 CORNELIA ST
Practice Address - Street 2:SUITE 302
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2318
Practice Address - Country:US
Practice Address - Phone:518-561-8820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006405156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01879703Medicaid
NY02868142Medicaid
NY01879703Medicaid