Provider Demographics
NPI:1780788133
Name:FIEDLER, ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:FIEDLER
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 1:1175 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1211
Mailing Address - Country:US
Mailing Address - Phone:212-289-6500
Mailing Address - Fax:212-996-5042
Practice Address - Street 1:1175 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1211
Practice Address - Country:US
Practice Address - Phone:212-289-6500
Practice Address - Fax:212-996-5042
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099544207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
1152045OtherGHI
OC7088OtherHEALTHNET
1327684640001OtherCIGNA INSURANCE
NP618OtherOXFORD
NY00170127Medicaid
0120756OtherAETNA INSURANCE
0120756OtherAETNA INSURANCE
NY524051Medicare ID - Type Unspecified