Provider Demographics
NPI:1093704504
Name:GUENTHER, ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:GUENTHER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 3RD AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:SPRING LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07762-1450
Mailing Address - Country:US
Mailing Address - Phone:732-974-0996
Mailing Address - Fax:732-974-7206
Practice Address - Street 1:1405 3RD AVE
Practice Address - Street 2:STE 2
Practice Address - City:SPRING LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07762-1450
Practice Address - Country:US
Practice Address - Phone:732-974-0996
Practice Address - Fax:732-974-7206
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2018-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00125900213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1054406Medicaid
NJ449787Medicare ID - Type Unspecified
NJ1054406Medicaid