Provider Demographics
NPI:1245331834
Name:ZENENBERG, ROBERT D (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:ZENENBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 HANOVER RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1508
Mailing Address - Country:US
Mailing Address - Phone:973-736-2212
Mailing Address - Fax:973-736-2989
Practice Address - Street 1:83 HANOVER RD
Practice Address - Street 2:SUITE 290
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1508
Practice Address - Country:US
Practice Address - Phone:973-736-2212
Practice Address - Fax:973-736-2989
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07226200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8896607Medicaid
H43761Medicare UPIN
NJ049707A4GMedicare ID - Type Unspecified