Provider Demographics
NPI:1770696197
Name:CHATALBASH, ROBERT THOMAS (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:THOMAS
Last Name:CHATALBASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 EAST MAIN STREET
Mailing Address - Street 2:SUITE 21
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706
Mailing Address - Country:US
Mailing Address - Phone:631-968-8288
Mailing Address - Fax:631-968-8268
Practice Address - Street 1:375 EAST MAIN STREET
Practice Address - Street 2:SUITE 21
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-968-8288
Practice Address - Fax:631-968-8268
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1640901207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01257249Medicaid
E69859Medicare UPIN
NY01257249Medicaid