Provider Demographics
NPI:1841291580
Name:FEGAN, ROBERT J (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:FEGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 HIGHWAY 35 STE 200
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2216
Mailing Address - Country:US
Mailing Address - Phone:732-222-7373
Mailing Address - Fax:732-222-7372
Practice Address - Street 1:300 HIGHWAY 35 STE 200
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-2216
Practice Address - Country:US
Practice Address - Phone:732-222-7373
Practice Address - Fax:732-222-7372
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07202500207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH42260Medicare UPIN
NJ049326Medicare ID - Type Unspecified