Provider Demographics
NPI:1356420798
Name:ROBILOTTO, JOHN ROCCO (OD, PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROCCO
Last Name:ROBILOTTO
Suffix:
Gender:M
Credentials:OD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BAYLIS CT
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-3601
Mailing Address - Country:US
Mailing Address - Phone:646-820-0096
Mailing Address - Fax:
Practice Address - Street 1:133 E 54TH ST STE 200
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4538
Practice Address - Country:US
Practice Address - Phone:212-650-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK252152W00000X
NYTUV007040-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOD5856Medicaid
AKK163746Medicare PIN