Provider Demographics
NPI:1508077009
Name:DR. ROBERT O'BRIEN
Entity Type:Organization
Organization Name:DR. ROBERT O'BRIEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-782-7500
Mailing Address - Street 1:215 E LAUREL RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084-1361
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:215 E LAUREL RD
Practice Address - Street 2:SUITE 203
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1361
Practice Address - Country:US
Practice Address - Phone:856-782-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00451100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ091425Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER