Provider Demographics
NPI:1578562245
Name:INNELLA, ROBIN R (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:R
Last Name:INNELLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 STUYVESANT AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6936
Mailing Address - Country:US
Mailing Address - Phone:908-964-6600
Mailing Address - Fax:908-364-1025
Practice Address - Street 1:900 STUYVESANT AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6936
Practice Address - Country:US
Practice Address - Phone:908-964-6600
Practice Address - Fax:908-364-1025
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB42873207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1439103Medicaid
NJ4257897OtherAETNA
NJ222279894OtherCIGNA
NJ222279894OtherBLUE SHIELD OF NJ
NJ0043114OtherGHI
NJHS218OtherOXFORD
NJ0043114OtherGHI
NJHS218OtherOXFORD