Basic Information
| Provider Information | |||||||||
| NPI: | 1104147487 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARTRELL | ||||||||
| FirstName: | ROBYN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HARRIS | ||||||||
| OtherFirstName: | ROBYN | ||||||||
| OtherMiddleName: | G | ||||||||
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| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 161 FT WASHINGTN AVE | ||||||||
| Address2: | IP - 7 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123059770 | ||||||||
| FaxNumber: | 9133055848 | ||||||||
| Practice Location | |||||||||
| Address1: | 161 FT WASHINGTN AVE | ||||||||
| Address2: | IP - 7 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123059770 | ||||||||
| FaxNumber: | 9133055848 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2010 | ||||||||
| LastUpdateDate: | 12/10/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 94-07495 | KS | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 271105 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.