Provider Demographics
NPI:1164700936
Name:ROBERT W. DEVINE JR.
Entity Type:Organization
Organization Name:ROBERT W. DEVINE JR.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HHA/CAREGIVER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSALIA
Authorized Official - Middle Name:MARCOS
Authorized Official - Last Name:RODRIGO
Authorized Official - Suffix:
Authorized Official - Credentials:CHHA/CNA
Authorized Official - Phone:732-354-0089
Mailing Address - Street 1:126 AINSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1211
Mailing Address - Country:US
Mailing Address - Phone:732-354-0089
Mailing Address - Fax:
Practice Address - Street 1:126 AINSWORTH AVE
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1211
Practice Address - Country:US
Practice Address - Phone:732-354-0089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NH12487200251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health