Provider Demographics
NPI:1629378906
Name:PASSAMENTI, ROBERT (RPA-C)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:PASSAMENTI
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 HIGBIE LN
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-3923
Mailing Address - Country:US
Mailing Address - Phone:631-587-0940
Mailing Address - Fax:631-587-2073
Practice Address - Street 1:108 HIGBIE LN
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-3923
Practice Address - Country:US
Practice Address - Phone:631-587-0940
Practice Address - Fax:631-587-2092
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014444363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical