Provider Demographics
NPI:1477593069
Name:BACSIK, ROBERT DENNIS (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DENNIS
Last Name:BACSIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 HARRIS DR
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-4205
Mailing Address - Country:US
Mailing Address - Phone:315-782-4391
Mailing Address - Fax:315-788-8319
Practice Address - Street 1:435 HARRIS DR
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4205
Practice Address - Country:US
Practice Address - Phone:315-782-4391
Practice Address - Fax:315-788-8319
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160756208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY978230Medicaid