Provider Demographics
NPI:1730235615
Name:FLUEGEL, ROBERT JOHN (PT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOHN
Last Name:FLUEGEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 2ND AVE
Mailing Address - Street 2:(IN HYPE GYM)
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9151
Mailing Address - Country:US
Mailing Address - Phone:646-801-2016
Mailing Address - Fax:646-417-7176
Practice Address - Street 1:480 2ND AVE
Practice Address - Street 2:(IN HYPE GYM)
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9151
Practice Address - Country:US
Practice Address - Phone:646-801-2016
Practice Address - Fax:646-417-7176
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019564174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ401B1Medicare PIN