Provider Demographics
NPI:1871564005
Name:BLISS, ROBIN L (MD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:L
Last Name:BLISS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 E MAIN ST
Mailing Address - Street 2:BLDG C
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2874
Mailing Address - Country:US
Mailing Address - Phone:631-724-8585
Mailing Address - Fax:631-265-1528
Practice Address - Street 1:200 MOTOR PKWY
Practice Address - Street 2:SUITE D22
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-5100
Practice Address - Country:US
Practice Address - Phone:631-435-4322
Practice Address - Fax:631-435-3423
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181368207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY62K231Medicare ID - Type Unspecified
NYF28689Medicare UPIN