Basic Information
| Provider Information | |||||||||
| NPI: | 1649280397 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHENEY | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1367 WASHINGTON AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122061043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184892666 | ||||||||
| FaxNumber: | 5184895933 | ||||||||
| Practice Location | |||||||||
| Address1: | 1367 WASHINGTON AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122061043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184892666 | ||||||||
| FaxNumber: | 5184895933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 02/25/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0117X | 202975-9 | NY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | 01669878 | 05 | NY | MEDICAID | 000405017004 | 01 | NY | BS NENY | OTHER | 5735691 | 01 | NY | AETNA | OTHER | 10002484 | 01 | NY | CDPHP | OTHER | 18223 | 01 | NY | MVP | OTHER | 437451 | 01 | NY | EMPIRE BC | OTHER |