Provider Demographics
NPI:1790786689
Name:HACKFORD, ROBERT R JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:HACKFORD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S MAIN ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-2264
Mailing Address - Country:US
Mailing Address - Phone:609-463-1577
Mailing Address - Fax:
Practice Address - Street 1:211 S MAIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2264
Practice Address - Country:US
Practice Address - Phone:609-463-1577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA081110002080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F56054Medicare UPIN