Provider Demographics
NPI:1952416216
Name:ARLEO, ROBERT J (MD, PC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:ARLEO
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 UPTOWN RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1632
Mailing Address - Country:US
Mailing Address - Phone:607-257-5599
Mailing Address - Fax:607-257-3972
Practice Address - Street 1:100 UPTOWN RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1632
Practice Address - Country:US
Practice Address - Phone:607-257-5599
Practice Address - Fax:607-257-3972
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195703-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01478266Medicaid
NYRA9017Medicare ID - Type Unspecified
NY5576860001Medicare NSC
NY01478266Medicaid