MEDICARE: PEDRO GONZALO ROBLEJO SR. 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	208800000X	Urology Physician		NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P43822794	OTHER		MULTIPLAN
2	96238	OTHER	NY	EMPIRE BC

General Provider Information

NPI Number	:	1568542249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEDRO GONZALO ROBLEJO SR. 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	:	201-868-0160

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	:	201-868-0160

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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