Provider Demographics
NPI:1174511075
Name:THIELE, ROBERT PATRICK (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PATRICK
Last Name:THIELE
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 1:9 MONROE STREET
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807
Mailing Address - Country:US
Mailing Address - Phone:908-231-1114
Mailing Address - Fax:908-252-1930
Practice Address - Street 1:9 MONROE ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3043
Practice Address - Country:US
Practice Address - Phone:908-231-1114
Practice Address - Fax:908-252-1930
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00258300213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8500207Medicaid
NJ8500207Medicaid
NJ045735-DGLMedicare ID - Type Unspecified