Provider Demographics
NPI:1447451687
Name:DRINKWINE, ROBERT P
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:DRINKWINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 OLD MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:NY
Mailing Address - Zip Code:12946-1939
Mailing Address - Country:US
Mailing Address - Phone:518-523-2464
Mailing Address - Fax:518-523-1401
Practice Address - Street 1:185 OLD MILITARY RD
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:NY
Practice Address - Zip Code:12946-1939
Practice Address - Country:US
Practice Address - Phone:518-523-2464
Practice Address - Fax:518-523-1401
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016993225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY141731786OtherHOSPITAL TAX ID #
NY016993OtherLICENSE
NY016993OtherLICENSE
NY141731786OtherHOSPITAL TAX ID #
NY33U079Medicare ID - Type UnspecifiedHOSPITAL MCR SWING BED #