Provider Demographics
NPI:1841514270
Name:PAINO, ROBERT
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:PAINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 CHATHAM TER
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3946
Mailing Address - Country:US
Mailing Address - Phone:973-773-1865
Mailing Address - Fax:973-473-8387
Practice Address - Street 1:105 TERHUNE AVE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-2805
Practice Address - Country:US
Practice Address - Phone:973-473-2243
Practice Address - Fax:973-473-8387
Is Sole Proprietor?:No
Enumeration Date:2010-03-13
Last Update Date:2010-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01399300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist