Provider Demographics
NPI:1497144430
Name:AUSTIN, ROBERT (APN)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 COOPER ST
Mailing Address - Street 2:
Mailing Address - City:DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2571
Mailing Address - Country:US
Mailing Address - Phone:856-848-6346
Mailing Address - Fax:856-848-5734
Practice Address - Street 1:849 COOPER ST
Practice Address - Street 2:
Practice Address - City:DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-2571
Practice Address - Country:US
Practice Address - Phone:856-848-6346
Practice Address - Fax:856-848-5734
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR12388200363LP0200X
NJ26NJ00552600363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics