Provider Demographics
NPI:1235164823
Name:MIDOUHAS, ROBIN G (APN)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:G
Last Name:MIDOUHAS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 EAST BAY AVENUE
Mailing Address - Street 2:SUITE 21-C
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050
Mailing Address - Country:US
Mailing Address - Phone:609-597-5327
Mailing Address - Fax:609-756-4452
Practice Address - Street 1:712 EAST BAY AVENUE
Practice Address - Street 2:SUITE 21-C
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050
Practice Address - Country:US
Practice Address - Phone:609-597-5327
Practice Address - Fax:609-756-4452
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC05720000364SP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7210604Medicaid