Provider Demographics
NPI:1457684268
Name:BRISTOL, ROBERT F (ATC, LAT, AEMT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:F
Last Name:BRISTOL
Suffix:
Gender:M
Credentials:ATC, LAT, AEMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 SHELLBANK PL
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5833
Mailing Address - Country:US
Mailing Address - Phone:516-319-8570
Mailing Address - Fax:
Practice Address - Street 1:78 SHELLBANK PL
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5833
Practice Address - Country:US
Practice Address - Phone:516-319-8570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY356641146N00000X
NY20000017012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic