Healthcare Provider Details

I. General information

NPI: 1407880115
Provider Name (Legal Business Name): ROBERT J DAGOSTINI JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 RIDGEDALE AVE
CEDAR KNOLLS NJ
07927-2111
US

IV. Provider business mailing address

1590 ROUTE 206 NORTH
BEDMINSTER NJ
07921
US

V. Phone/Fax

Practice location:
  • Phone: 973-538-2334
  • Fax: 908-234-2022
Mailing address:
  • Phone: 973-538-2334
  • Fax: 908-234-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MA04611100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: