Provider Demographics
NPI:1013004902
Name:LABACZEWSKI, ROBERT JOSEPH (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOSEPH
Last Name:LABACZEWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HERITAGE VALLEY DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-1752
Mailing Address - Country:US
Mailing Address - Phone:856-582-2469
Mailing Address - Fax:856-218-0544
Practice Address - Street 1:100 HERITAGE VALLEY DR
Practice Address - Street 2:SUITE 2
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-1752
Practice Address - Country:US
Practice Address - Phone:856-582-2469
Practice Address - Fax:856-218-0544
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB02890100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJLA162222AWDMedicare ID - Type Unspecified
NJE06102Medicare UPIN