Provider Demographics
NPI:1639360282
Name:PEDRO G ROBLEJO MD
Entity Type:Organization
Organization Name:PEDRO G ROBLEJO MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD UROLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:GONZALO
Authorized Official - Last Name:ROBLEJO
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:201-868-0821
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:09093-2112
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:09093-2112
Practice Address - Country:US
Practice Address - Phone:201-868-0821
Practice Address - Fax:201-868-0160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02346000208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
460364Medicare PIN
D19183Medicare UPIN