Provider Demographics
NPI:1134129232
Name:PANEBIANCO, ROBERT A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:PANEBIANCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4 ETHEL RD
Mailing Address - Street 2:SUITE 406B
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2841
Mailing Address - Country:US
Mailing Address - Phone:732-287-6622
Mailing Address - Fax:732-287-2233
Practice Address - Street 1:4 ETHEL RD
Practice Address - Street 2:SUITE 406B
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2841
Practice Address - Country:US
Practice Address - Phone:732-287-6622
Practice Address - Fax:732-287-2233
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05559500207R00000X, 207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F79873Medicare UPIN
NJ865662Medicare PIN