Provider Demographics
NPI:1336167907
Name:ROBINSON, DENISE GEORGETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:GEORGETTE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DENISE
Other - Middle Name:GEORGETTE
Other - Last Name:BRATHWAITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:127 W SEAMAN AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-1545
Mailing Address - Country:US
Mailing Address - Phone:516-379-0415
Mailing Address - Fax:516-379-2516
Practice Address - Street 1:127 W SEAMAN AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-1545
Practice Address - Country:US
Practice Address - Phone:516-379-0415
Practice Address - Fax:516-379-2516
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137495208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY479410Medicaid
NY479410Medicaid