Provider Demographics
NPI:1659429355
Name:EGERMAYER, ROBERT W (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:EGERMAYER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1325
Mailing Address - Country:US
Mailing Address - Phone:201-444-9110
Mailing Address - Fax:201-444-3365
Practice Address - Street 1:522 S BROAD ST
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-1325
Practice Address - Country:US
Practice Address - Phone:201-444-9110
Practice Address - Fax:201-444-3365
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQAO06740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
22-3733292OtherTAX IDENTIFICATION NUMBER
045403Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID