Healthcare Provider Details

I. General information

NPI: 1790881035
Provider Name (Legal Business Name): ROBERT SENESE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 CINCINNATI AVE
EGG HARBOR CITY NJ
08215-1926
US

IV. Provider business mailing address

2500 ENGLISH CREEK AVE
EGG HARBOR TWP NJ
08234-5549
US

V. Phone/Fax

Practice location:
  • Phone: 856-968-7433
  • Fax:
Mailing address:
  • Phone: 856-968-7433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB18242
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: