Provider Demographics
NPI:1255494670
Name:SEMEGRAN, ROBIN HELENE (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:HELENE
Last Name:SEMEGRAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 OLD TAPPAN ROAD
Mailing Address - Street 2:
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675
Mailing Address - Country:US
Mailing Address - Phone:201-664-5596
Mailing Address - Fax:201-664-5611
Practice Address - Street 1:216 OLD TAPPAN ROAD
Practice Address - Street 2:
Practice Address - City:OLD TAPPAN
Practice Address - State:NJ
Practice Address - Zip Code:07675
Practice Address - Country:US
Practice Address - Phone:201-664-5596
Practice Address - Fax:201-664-5611
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4467152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU32585Medicare UPIN
727662Medicare ID - Type Unspecified