Provider Demographics
NPI:1437220159
Name:DENNIS, ROBERT I (MD, PA,)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:I
Last Name:DENNIS
Suffix:
Gender:M
Credentials:MD, PA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 6TH AVE
Mailing Address - Street 2:SUITE 1 DOOR B
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6101
Mailing Address - Country:US
Mailing Address - Phone:732-775-5189
Mailing Address - Fax:732-775-3065
Practice Address - Street 1:2040 6TH AVE
Practice Address - Street 2:SUITE 1 DOOR B
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-6101
Practice Address - Country:US
Practice Address - Phone:732-775-5189
Practice Address - Fax:732-775-3065
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA25988207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ010847Medicare ID - Type Unspecified