Provider Demographics
NPI:1801134838
Name:OPTIMUM MEDICAL CARE LLC
Entity type:Organization
Organization Name:OPTIMUM MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROBLEJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-285-1626
Mailing Address - Street 1:629 AMBOY AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3579
Mailing Address - Country:US
Mailing Address - Phone:732-486-3200
Mailing Address - Fax:877-524-7276
Practice Address - Street 1:97 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-2248
Practice Address - Country:US
Practice Address - Phone:201-426-4550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA070745002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty