Provider Demographics
NPI:1396805685
Name:CILLEY, ROBERT STORM (MED, ATC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:STORM
Last Name:CILLEY
Suffix:
Gender:M
Credentials:MED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-3425
Mailing Address - Country:US
Mailing Address - Phone:315-393-1700
Mailing Address - Fax:315-393-1700
Practice Address - Street 1:933 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-3425
Practice Address - Country:US
Practice Address - Phone:315-393-1700
Practice Address - Fax:315-393-1700
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056475146M00000X
NY000288-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer