Provider Demographics
NPI:1831628205
Name:GADOMSKI, ROBERT III (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GADOMSKI
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 VARICK ST FL 9
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-4810
Mailing Address - Country:US
Mailing Address - Phone:212-620-0340
Mailing Address - Fax:
Practice Address - Street 1:200 VARICK ST FL 9
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-4810
Practice Address - Country:US
Practice Address - Phone:212-620-0340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0206882084P0800X
PAOT018005390200000X
NY309017-012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program