Provider Demographics
NPI:1750422812
Name:MCMULLEN, ROBERT D
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:MCMULLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:D
Other - Last Name:MCMULLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PC
Mailing Address - Street 1:171 W 79TH ST # 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6449
Mailing Address - Country:US
Mailing Address - Phone:212-362-9635
Mailing Address - Fax:212-362-3997
Practice Address - Street 1:171 W 79TH ST # 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6449
Practice Address - Country:US
Practice Address - Phone:212-362-9635
Practice Address - Fax:212-362-3997
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1318952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry