Provider Demographics
NPI:1356394431
Name:NUBA, ROBERT SAMUEL (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:SAMUEL
Last Name:NUBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1385 BROADWAY
Mailing Address - Street 2:A31
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1364
Mailing Address - Country:US
Mailing Address - Phone:516-400-9015
Mailing Address - Fax:516-400-9015
Practice Address - Street 1:1385 BROADWAY
Practice Address - Street 2:SUITE A31
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1364
Practice Address - Country:US
Practice Address - Phone:516-400-9015
Practice Address - Fax:516-400-9015
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1300682085R0202X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY49A071OtherMEDICARE ID
NY00593260Medicaid
NY00593260Medicaid