Provider Demographics
NPI:1528175361
Name:DRACKER, ROBERT ALBERT (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALBERT
Last Name:DRACKER
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 1:4811 BUCKLEY RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3676
Mailing Address - Country:US
Mailing Address - Phone:315-457-3091
Mailing Address - Fax:315-457-4305
Practice Address - Street 1:4811 BUCKLEY RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3676
Practice Address - Country:US
Practice Address - Phone:315-457-3091
Practice Address - Fax:315-457-4305
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155177-1207ZB0001X
NY155177208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01555068Medicaid
NY155177-1OtherMEDICAL LICENSE
NY01555068Medicaid
NYE28170Medicare UPIN