Provider Demographics
NPI:1790134153
Name:ROBINSON, L T JR (LPN)
Entity Type:Individual
Prefix:
First Name:L T
Middle Name:
Last Name:ROBINSON
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:MR
Other - First Name:L T
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:237 PARK PL APT 4
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-4163
Mailing Address - Country:US
Mailing Address - Phone:201-667-7137
Mailing Address - Fax:
Practice Address - Street 1:6321 NEW UTRECHT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-5425
Practice Address - Country:US
Practice Address - Phone:212-687-7464
Practice Address - Fax:212-257-7016
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234220320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities