Provider Demographics
NPI:1942217112
Name:PINE, ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:PINE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 W SAINT GEORGES AVE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-5648
Mailing Address - Country:US
Mailing Address - Phone:908-486-2700
Mailing Address - Fax:908-925-2800
Practice Address - Street 1:728 W SAINT GEORGES AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-5648
Practice Address - Country:US
Practice Address - Phone:908-486-2700
Practice Address - Fax:908-925-2800
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00426100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3153509Medicaid
521582Medicare ID - Type Unspecified
NJ3153509Medicaid