Healthcare Provider Details

I. General information

NPI: 1902093560
Provider Name (Legal Business Name): ROBERT I GREENBLATT MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 MORRIS AVE SUITE B6
UNION NJ
07083-5752
US

IV. Provider business mailing address

2333 MORRIS AVE SUITE B6
UNION NJ
07083-5752
US

V. Phone/Fax

Practice location:
  • Phone: 908-964-1144
  • Fax: 908-964-7646
Mailing address:
  • Phone: 908-964-1144
  • Fax: 908-964-7646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA04478800
License Number StateNJ

VIII. Authorized Official

Name: ROBERT I GREENBLATT
Title or Position: OWNER
Credential: MD
Phone: 908-964-1144