Individual
ROBERT ANTHONY RISELVATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
763 LARKFIELD RD FL 2, COMMACK, NY 11725-3131
(631) 462-2225
(631) 462-2804
Mailing address
763 LARKFIELD RD FL 2, COMMACK, NY 11725-3131
(631) 462-2225
(631) 462-2804
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
P54292
NY
363AS0400X
Surgical Physician Assistant
Primary
012994
NY
Other
Enumeration date
12/06/2006
Last updated
10/04/2010
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