Provider Demographics
NPI:1134607518
Name:BAILEY, ROBIN (MASTER'S OF HUMAN SE)
Entity type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MASTER'S OF HUMAN SE
Other - Prefix:MS
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:21 LACKAWANNA PL APT 552
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2961
Mailing Address - Country:US
Mailing Address - Phone:973-885-3381
Mailing Address - Fax:973-372-0162
Practice Address - Street 1:531-533 SOUTH ORANGE AVENUE
Practice Address - Street 2:2ND. FL.
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-0700
Practice Address - Country:US
Practice Address - Phone:973-885-3381
Practice Address - Fax:973-885-3381
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0217200374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ452-84-1553OtherPRIVATE PAY