Provider Demographics
NPI:1598254948
Name:VALENTIN, ROBERT P
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:VALENTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 BEACON HILL DR
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1178
Mailing Address - Country:US
Mailing Address - Phone:856-366-5999
Mailing Address - Fax:856-295-0162
Practice Address - Street 1:2508 BEACON HILL DR
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-1178
Practice Address - Country:US
Practice Address - Phone:856-366-5999
Practice Address - Fax:856-295-0162
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJV02696587709705OtherDRIVERS LICENSE