Provider Demographics
NPI:1285669358
Name:INFECTIOUS DISEASE SPECIALISTS OF NJ, INC.
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE SPECIALISTS OF NJ, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:908-810-9200
Mailing Address - Street 1:1308 MORRIS AVE
Mailing Address - Street 2:204
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-3331
Mailing Address - Country:US
Mailing Address - Phone:908-810-9200
Mailing Address - Fax:908-810-9260
Practice Address - Street 1:1308 MORRIS AVE
Practice Address - Street 2:204
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3331
Practice Address - Country:US
Practice Address - Phone:908-810-9200
Practice Address - Fax:908-810-9260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB48316174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1971204Medicaid
NJ634943BBZMedicare ID - Type Unspecified
NJE61095Medicare UPIN