Provider Demographics
NPI:1073699294
Name:HEVERT, ROBERT A (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:HEVERT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:A
Other - Last Name:HEVERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1240 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090
Mailing Address - Country:US
Mailing Address - Phone:908-233-6330
Mailing Address - Fax:908-233-5636
Practice Address - Street 1:1240 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090
Practice Address - Country:US
Practice Address - Phone:908-233-6330
Practice Address - Fax:908-233-5636
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB02158400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2035103Medicaid
E06525Medicare UPIN
NJHE455986Medicare ID - Type Unspecified