=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053862748
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBENECA SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2016
-----------------------------------------------------
Last Update Date | 10/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2362 ROUTE 9 SUITE 2
-----------------------------------------------------
City | HOWELL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07731-4017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-481-1148
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 POINTE CIR
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08527-1600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ROGER L BENEDETTI
-----------------------------------------------------
Credential | RPH, BPHARM
-----------------------------------------------------
Telephone | 732-481-1148
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HP0197200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------