Provider Demographics
NPI:1154394930
Name:GIACOBBE, ROBERT C (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:GIACOBBE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:9 MEDICAL DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1591
Mailing Address - Country:US
Mailing Address - Phone:631-473-3900
Mailing Address - Fax:631-474-4475
Practice Address - Street 1:9 MEDICAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1591
Practice Address - Country:US
Practice Address - Phone:631-473-3900
Practice Address - Fax:631-474-4475
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1888891207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10J23WP541Medicare PIN
NYF80538Medicare UPIN