Provider Demographics
NPI:1831121631
Name:MELTZER, ROBERT MARC
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MARC
Last Name:MELTZER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 E 75TH ST
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2805
Mailing Address - Country:US
Mailing Address - Phone:212-879-4456
Mailing Address - Fax:212-772-7062
Practice Address - Street 1:103 E 75TH ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2805
Practice Address - Country:US
Practice Address - Phone:212-879-4456
Practice Address - Fax:212-772-7062
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145071207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B80475Medicare UPIN
15D481Medicare ID - Type Unspecified