Healthcare Provider Details

I. General information

NPI: 1588749303
Provider Name (Legal Business Name): ROBERT WORTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 TEANECK RD
TEANECK NJ
07666-4245
US

IV. Provider business mailing address

PO BOX 637728
CINCINNATI OH
45263-7728
US

V. Phone/Fax

Practice location:
  • Phone: 201-342-1205
  • Fax: 201-342-1259
Mailing address:
  • Phone: 201-842-3955
  • Fax: 201-205-1582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA07774000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: