Healthcare Provider Details

I. General information

NPI: 1548350556
Provider Name (Legal Business Name): ROY J COBB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 MAPLE AVE
MORRISTOWN NJ
07960-5250
US

IV. Provider business mailing address

504 SUMMIT AVE
MAPLEWOOD NJ
07040-1309
US

V. Phone/Fax

Practice location:
  • Phone: 973-267-1274
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number25MA05295400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: