Provider Demographics
NPI:1508272089
Name:IRIQUE ROBINSON
Entity Type:Organization
Organization Name:IRIQUE ROBINSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTEREDNURSE
Authorized Official - Prefix:
Authorized Official - First Name:IRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-398-6487
Mailing Address - Street 1:195 TEMPLE ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07522-1112
Mailing Address - Country:US
Mailing Address - Phone:201-398-6487
Mailing Address - Fax:973-904-0191
Practice Address - Street 1:195 TEMPLE ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07522-1112
Practice Address - Country:US
Practice Address - Phone:201-398-6487
Practice Address - Fax:973-904-0191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR12548900302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization