Provider Demographics
NPI:1881762698
Name:INCITTI, ROBERT NICK (PT OCS CSCI)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:NICK
Last Name:INCITTI
Suffix:
Gender:M
Credentials:PT OCS CSCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MECHANIC STREET
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1869
Mailing Address - Country:US
Mailing Address - Phone:732-747-0075
Mailing Address - Fax:732-747-5236
Practice Address - Street 1:65 MECHANIC STREET
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1869
Practice Address - Country:US
Practice Address - Phone:732-747-0075
Practice Address - Fax:732-747-5236
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00223500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
697613Medicare ID - Type Unspecified
R33518Medicare UPIN