Provider Demographics
NPI:1144345539
Name:CONCIATORI, ROBERT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:CONCIATORI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:79 MALBA DR
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1057
Mailing Address - Country:US
Mailing Address - Phone:718-767-2059
Mailing Address - Fax:718-767-2059
Practice Address - Street 1:71 TODT HILL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4534
Practice Address - Country:US
Practice Address - Phone:718-767-2059
Practice Address - Fax:718-767-2059
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1796932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01365755Medicaid
NY98F443Medicare UPIN