Provider Demographics
NPI:1881695500
Name:ROCHE-BARNETT, ROBERT ALLAN (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALLAN
Last Name:ROCHE-BARNETT
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 1:581 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-1916
Mailing Address - Country:US
Mailing Address - Phone:631-472-8100
Mailing Address - Fax:631-472-8811
Practice Address - Street 1:581 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-1916
Practice Address - Country:US
Practice Address - Phone:631-472-8100
Practice Address - Fax:631-472-8811
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176130-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11F321Medicare PIN
E08177Medicare UPIN