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General NPI Number Information
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NPI Number | 1003887704
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Entity Type | Individual
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Provider Name | ROBERT KOCH ILOWITE D.O.
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Gender | Male
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 505 OMNI DR THE DERMATOLOGY CENTER
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City | HILLSBOROUGH
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State | NJ
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Zip | 08844-4528
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Country | US
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Telephone | 908-359-6685
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Fax | 908-359-0649
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Provider Business Mailing Address
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Address Line | 505 OMNI DR THE DERMATOLOGY CENTER
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City | HILLSBOROUGH
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State | NJ
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Zip | 08844-4528
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Country | US
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Telephone | 908-359-6685
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Fax | 908-359-0649
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 25MB06116900
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License Number State | NJ
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