MEDICARE: PETER C ROBLEJO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	25MA07074500	NJ

General Provider Information

NPI Number	:	1063853737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER C ROBLEJO MD

Provider Business Mailing Address
First Line	:	5910 PALISADE AVE
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-2112
Country	:	US
Telephone Number	:	201-868-0821
Fax Number	:

Provider Business Practice Location Address
First Line	:	5910 PALISADE AVE
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-2112
Country	:	US
Telephone Number	:	201-868-0821
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PETER C ROBLEJO
Credential	:	MD
Telephone Number	:	201-868-0821

Provider Enumeration Date	:	07/10/2013
Last Update Date	:	07/10/2013

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