Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 307133 | NY |
NPI | 1073918041 |
---|---|
Provider Name | Mr. Craig Richard Robinson |
First Address | Uniondale, NY 11556 |
Second Address | Uniondale, NY 11556 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2014 |
Last Update Date | 24/08/2015 |