Provider Demographics
NPI:1992873897
Name:MUELLER, ROBERT JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOSEPH
Last Name:MUELLER
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:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:HARRIS
Mailing Address - State:NY
Mailing Address - Zip Code:12742-0421
Mailing Address - Country:US
Mailing Address - Phone:845-794-9864
Mailing Address - Fax:845-794-9868
Practice Address - Street 1:68 HARRIS BUSHVILLE ROAD
Practice Address - Street 2:
Practice Address - City:HARRIS
Practice Address - State:NY
Practice Address - Zip Code:12742-0800
Practice Address - Country:US
Practice Address - Phone:845-794-3300
Practice Address - Fax:845-794-9868
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0950752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB79113Medicare UPIN
NY72D371Medicare ID - Type UnspecifiedEMPIRE MEDICARE SERV