Provider Demographics
NPI:1679260475
Name:ROBAYO, LUIS EDWARD JR
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:EDWARD
Last Name:ROBAYO
Suffix:JR
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 1:214 NASSAU BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY SOUTH
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5655
Mailing Address - Country:US
Mailing Address - Phone:855-567-6867
Mailing Address - Fax:
Practice Address - Street 1:214 NASSAU BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY SOUTH
Practice Address - State:NY
Practice Address - Zip Code:11530-5655
Practice Address - Country:US
Practice Address - Phone:855-567-6867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist