Provider Demographics
NPI:1386723088
Name:WOLTMAN, ROBERT T (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:T
Last Name:WOLTMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2035 LAKEVILLE RD STE 207
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1661
Mailing Address - Country:US
Mailing Address - Phone:516-326-4709
Mailing Address - Fax:516-326-8968
Practice Address - Street 1:2035 LAKEVILLE RD STE 207
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1661
Practice Address - Country:US
Practice Address - Phone:516-326-4709
Practice Address - Fax:516-326-8968
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005361213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01789871Medicaid
NYU67558Medicare UPIN
NY01789871Medicaid