Provider Demographics
NPI:1235468034
Name:ROBERT T. LATIMER, MD PA
Entity Type:Organization
Organization Name:ROBERT T. LATIMER, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:LATIMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-746-2250
Mailing Address - Street 1:24 PORTLAND PL
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2822
Mailing Address - Country:US
Mailing Address - Phone:973-746-2250
Mailing Address - Fax:973-746-9575
Practice Address - Street 1:24 PORTLAND PL
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2822
Practice Address - Country:US
Practice Address - Phone:973-746-2250
Practice Address - Fax:973-746-9575
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT T. LATIMER, MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA018001002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F28004Medicare UPIN