Provider Demographics
NPI:1427046689
Name:LAITMAN, ROBERT S (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:LAITMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2510 WESTCHESTER AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3585
Mailing Address - Country:US
Mailing Address - Phone:718-518-1276
Mailing Address - Fax:718-518-1281
Practice Address - Street 1:2510 WESTCHESTER AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3585
Practice Address - Country:US
Practice Address - Phone:718-518-1276
Practice Address - Fax:718-518-1281
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2012-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY163283207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01495436Medicaid
A61439Medicare UPIN
NY23E871Medicare ID - Type Unspecified