Provider Demographics
NPI:1396941563
Name:BELLO, ROBERT FRED (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FRED
Last Name:BELLO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 WESTMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-8124
Mailing Address - Country:US
Mailing Address - Phone:646-296-5688
Mailing Address - Fax:
Practice Address - Street 1:760 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-6014
Practice Address - Country:US
Practice Address - Phone:631-242-1181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005827213ES0103X
PASC005887213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery