Provider Demographics
NPI:1568542249
Name:ROBLEJO, PEDRO GONZALO SR (MD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:GONZALO
Last Name:ROBLEJO
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-2112
Mailing Address - Country:US
Mailing Address - Phone:201-868-0821
Mailing Address - Fax:201-868-0160
Practice Address - Street 1:5910 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-2112
Practice Address - Country:US
Practice Address - Phone:201-868-0821
Practice Address - Fax:201-868-0160
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P43822794OtherMULTIPLAN
NY96238OtherEMPIRE BC
PA460364Medicare ID - Type Unspecified
D19183Medicare UPIN