Provider Demographics
NPI:1396710661
Name:LARDIERE, ROBERT F (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:F
Last Name:LARDIERE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 CENTRE ST
Mailing Address - Street 2:STE 2
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2877
Mailing Address - Country:US
Mailing Address - Phone:973-667-5070
Mailing Address - Fax:973-667-5070
Practice Address - Street 1:230 CENTRE ST
Practice Address - Street 2:STE 2
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2877
Practice Address - Country:US
Practice Address - Phone:973-667-5070
Practice Address - Fax:973-667-5070
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00149400213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1868705Medicaid
NJ1868705Medicaid
177813Medicare ID - Type Unspecified