Healthcare Provider Details

I. General information

NPI: 1124192323
Provider Name (Legal Business Name): MORRIS ROBERT MORIN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PROSPECT AVE
HACKENSACK NJ
07601-2233
US

IV. Provider business mailing address

125 PROSPECT AVE
HACKENSACK NJ
07601-2233
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-7577
  • Fax: 201-488-1807
Mailing address:
  • Phone: 201-488-7577
  • Fax: 201-488-1807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberMD000943
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0844890001
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerDMERC
# 2
Identifier1823507
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 3
IdentifierBS021
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerOXFORD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: