Healthcare Provider Details

I. General information

NPI: 1174554471
Provider Name (Legal Business Name): ROBERT A DEFALCO JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 BILBY RD SUITE 201
HACKETTSTOWN NJ
07840-4174
US

IV. Provider business mailing address

108 BILBY RD SUITE 201
HACKETTSTOWN NJ
07840-4174
US

V. Phone/Fax

Practice location:
  • Phone: 908-684-3005
  • Fax: 908-684-3301
Mailing address:
  • Phone: 908-684-3005
  • Fax: 908-684-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number25MB069711
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: