Provider Demographics
NPI:1013909803
Name:PLATT, ROBERT NELSON (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:NELSON
Last Name:PLATT
Suffix:
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 1:1485 UNION VALLEY RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480-1336
Mailing Address - Country:US
Mailing Address - Phone:973-728-1880
Mailing Address - Fax:973-728-1559
Practice Address - Street 1:1485 UNION VALLEY RD
Practice Address - Street 2:SUITE D
Practice Address - City:WEST MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07480-1336
Practice Address - Country:US
Practice Address - Phone:973-728-1880
Practice Address - Fax:973-728-1559
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA32615207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3054403Medicaid
NJ526746Medicare ID - Type Unspecified
NJ3054403Medicaid