Healthcare Provider Details

I. General information

NPI: 1548265754
Provider Name (Legal Business Name): ROBERT ROY BLANK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 SCHANCK RD STE 302
FREEHOLD NJ
07728-3068
US

IV. Provider business mailing address

222 SCHANCK ROAD, STE 302
FREEHOLD NJ
07728
UM

V. Phone/Fax

Practice location:
  • Phone: 732-577-1999
  • Fax: 732-845-5356
Mailing address:
  • Phone: 732-577-1999
  • Fax: 732-845-5356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA04837500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: