Provider Demographics
NPI:1164127767
Name:ROOBLE, FNU (MD)
Entity type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:ROOBLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10-42 MITCHELL AVE STE 1000
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903-1617
Mailing Address - Country:US
Mailing Address - Phone:607-772-8772
Mailing Address - Fax:
Practice Address - Street 1:1042 MITCHELL AVE # 42
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-1678
Practice Address - Country:US
Practice Address - Phone:607-772-8772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2024-06-13
Deactivation Date:2023-11-06
Deactivation Code:
Reactivation Date:2023-11-21
Provider Licenses
StateLicense IDTaxonomies
PAMT2286642084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMT228664OtherTRAINING LICENSE