Provider Demographics
NPI:1437155041
Name:PINKE, ROBERT SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SCOTT
Last Name:PINKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:SCOTT
Other - Last Name:PINKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:66 SUNSET STRIP
Mailing Address - Street 2:STE 107
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1362
Mailing Address - Country:US
Mailing Address - Phone:973-584-4451
Mailing Address - Fax:973-584-2099
Practice Address - Street 1:66 SUNSET STRIP
Practice Address - Street 2:STE 107
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1362
Practice Address - Country:US
Practice Address - Phone:973-584-4451
Practice Address - Fax:973-584-2099
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2010-05-18
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05160800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJIS360OtherOXFORD
NJ0661007Medicaid
NJ1027823OtherAETNA
NJOK5366OtherHEALTHNET
NJ180035676OtherRAILROAD MEDICARE
NJ180035676OtherRAILROAD MEDICARE
NJ1027823OtherAETNA