Robert Paul Edgar, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

226744-1 Issued in NY

Practice address

30204 State Route 3
Black River, NY 13612-2091

Phone

(315) 773-9012

NPI assigned

Jul 15, 2007

Last updated

Jul 15, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184457600000",
    "number": "1235338799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "817 FRANKLIN ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136013411",
            "telephone_number": "315-782-8876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30204 STATE ROUTE 3",
            "city": "BLACK RIVER",
            "state": "NY",
            "postal_code": "136122091",
            "telephone_number": "315-773-9012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDGAR",
        "first_name": "ROBERT",
        "middle_name": "PAUL",
        "name_prefix": "Mr.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-15",
        "last_updated": "2007-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "226744-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02457972",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Black River Ambulance Squad, Inc
• Black River Dental PLLC
• Vincent Anthony Cesario Jr., D.M.D.
• April Eldridge
• Elizabeth Leigh Elmer, MS
• Melissa Farman
• Ashlie Hall
• Olga Harbuz

• Licensed Practical Nurse in Black River, NY
• Providers in Black River, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.