Provider Demographics
NPI:1275879215
Name:ROBERT L WELLNER
Entity Type:Organization
Organization Name:ROBERT L WELLNER
Other - Org Name:PATIENT CENTERED MEDICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:WELLNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-358-1788
Mailing Address - Street 1:10 FORRESTAL RD S
Mailing Address - Street 2:SUITE 209
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6666
Mailing Address - Country:US
Mailing Address - Phone:609-720-0032
Mailing Address - Fax:609-720-0034
Practice Address - Street 1:10 FORRESTAL RD S
Practice Address - Street 2:SUITE 209
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6666
Practice Address - Country:US
Practice Address - Phone:609-720-0032
Practice Address - Fax:609-720-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X, 208VP0000X
NJ25MB07771400207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
269738OtherMEDICARE PTAN