Provider Demographics
NPI:1952357766
Name:REFF, ROBERT ALAN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
Last Name:REFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2001
Mailing Address - Country:US
Mailing Address - Phone:312-981-3370
Mailing Address - Fax:312-981-3375
Practice Address - Street 1:102 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2001
Practice Address - Country:US
Practice Address - Phone:312-981-3370
Practice Address - Fax:312-981-3375
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA115137002084P0800X
IN01044544A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01044544AMedicaid
IL036064917Medicaid
ILK27248Medicare ID - Type UnspecifiedPROVIDER NUMBER
INC46188Medicare UPIN
IL036064917Medicaid
ILK27248Medicare PIN
IN01044544AMedicaid
IN234110Medicare PIN