Provider Demographics
NPI:1255547824
Name:ATIENZA, ROBIVAR MERCADO (ACUPUNCTURIST)
Entity type:Individual
Prefix:
First Name:ROBIVAR
Middle Name:MERCADO
Last Name:ATIENZA
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 LONERGAN DR
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-6236
Mailing Address - Country:US
Mailing Address - Phone:845-893-5633
Mailing Address - Fax:
Practice Address - Street 1:222 ROUTE 59 STE 201
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5206
Practice Address - Country:US
Practice Address - Phone:845-893-5633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001980171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist