Provider Demographics
NPI:1043384233
Name:BLOZEN, ROBERT A JR (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:BLOZEN
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 STATE ROUTE 35
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1084
Mailing Address - Country:US
Mailing Address - Phone:732-671-7277
Mailing Address - Fax:732-671-5952
Practice Address - Street 1:2124 STATE ROUTE 35
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1084
Practice Address - Country:US
Practice Address - Phone:732-671-7277
Practice Address - Fax:732-671-5952
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00308000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1108701Medicaid
NJ446768Medicare PIN