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General NPI Number Information
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NPI Number | 1235468034
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Entity Type | Organization
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Legal Business Name | ROBERT T. LATIMER, MD PA
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Dates
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Enumeration Date | 12/08/2009
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Last Update Date | 12/08/2009
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Provider Practice Location Address
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Address Line | 24 PORTLAND PL
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2822
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Country | US
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Telephone | 973-746-2250
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Fax | 973-746-9575
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Provider Business Mailing Address
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Address Line | 24 PORTLAND PL
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2822
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Country | US
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Telephone | 973-746-2250
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Fax | 973-746-9575
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT T LATIMER
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Credential | MD
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Telephone | 973-746-2250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MA01800100
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License Number State | NJ
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