Provider Demographics
NPI:1588699474
Name:CARLUCCI-MURPHY, ROBIN
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:CARLUCCI-MURPHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 GRACE CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-5162
Mailing Address - Country:US
Mailing Address - Phone:718-806-1434
Mailing Address - Fax:718-808-1435
Practice Address - Street 1:220 GRACE CHURCH ST
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-5162
Practice Address - Country:US
Practice Address - Phone:914-939-7828
Practice Address - Fax:914-939-4516
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0049751213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU34505Medicare UPIN
NYP56011Medicare PIN
NY6083950001Medicare NSC