Provider Demographics
NPI:1659532943
Name:DR ROBERT LILLIE, LLC
Entity Type:Organization
Organization Name:DR ROBERT LILLIE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:LILLIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-787-4747
Mailing Address - Street 1:55 LEONARDVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BELFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07718-1042
Mailing Address - Country:US
Mailing Address - Phone:732-787-4747
Mailing Address - Fax:732-495-9123
Practice Address - Street 1:55 LEONARDVILLE RD
Practice Address - Street 2:
Practice Address - City:BELFORD
Practice Address - State:NJ
Practice Address - Zip Code:07718-1042
Practice Address - Country:US
Practice Address - Phone:732-787-4747
Practice Address - Fax:732-495-9123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01309213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4696204Medicaid
NJ4696204Medicaid
6152140002Medicare NSC