Provider Demographics
NPI:1902453467
Name:MYTELKA, ROBERT B
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:MYTELKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 CHESTNUT RIDGE RD UNIT 223
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10977-6443
Mailing Address - Country:US
Mailing Address - Phone:845-558-7573
Mailing Address - Fax:
Practice Address - Street 1:750 CHESTNUT RIDGE RD UNIT 223
Practice Address - Street 2:
Practice Address - City:CHESTNUT RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10977-6443
Practice Address - Country:US
Practice Address - Phone:845-517-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist