Provider Demographics
NPI:1871649582
Name:ROBERTSON, JANET A (MD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:A
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 MINE BROOK RD
Mailing Address - Street 2:
Mailing Address - City:BERNARDSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07924-2109
Mailing Address - Country:US
Mailing Address - Phone:908-766-6110
Mailing Address - Fax:908-766-0569
Practice Address - Street 1:169 MINE BROOK RD
Practice Address - Street 2:
Practice Address - City:BERNARDSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07924-2109
Practice Address - Country:US
Practice Address - Phone:908-766-6110
Practice Address - Fax:908-766-0569
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04897400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223563506OtherTAX I.D.
NJE23791Medicare UPIN
NJ571031Medicare PIN