Provider Demographics
NPI:1215518253
Name:ROBINSON, TIFFANY T
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:T
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6585 162ND ST APT 6D
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2657
Mailing Address - Country:US
Mailing Address - Phone:631-522-3295
Mailing Address - Fax:
Practice Address - Street 1:1909 LONGFELLOW AVE
Practice Address - Street 2:
Practice Address - City:THE BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460
Practice Address - Country:US
Practice Address - Phone:347-497-3998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty