Provider Demographics
NPI:1053436436
Name:ROBERT L. BARD, M.D., P.C.
Entity type:Organization
Organization Name:ROBERT L. BARD, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT -RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LAURANCE
Authorized Official - Last Name:BARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-355-7017
Mailing Address - Street 1:121 E 60TH ST
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1117
Mailing Address - Country:US
Mailing Address - Phone:212-355-7017
Mailing Address - Fax:212-752-6192
Practice Address - Street 1:121 E 60TH ST
Practice Address - Street 2:SUITE 6A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1117
Practice Address - Country:US
Practice Address - Phone:212-355-7017
Practice Address - Fax:212-752-6192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103811-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00180245Medicaid
NYC07792Medicare UPIN
NYWER051Medicare ID - Type Unspecified