MEDICARE: ROBERT PARKER DPM

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	213E00000X	Podiatrist	25MD000079900	NJ

General Provider Information

NPI Number	:	1912091570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT PARKER DPM

Provider Business Mailing Address
First Line	:	1156 LIBERTY AVENUE
Second Line	:
City	:	HILLSIDE
State	:	NJ
Zip	:	07205-0000
Country	:	US
Telephone Number	:	908-351-1626
Fax Number	:

Provider Business Practice Location Address
First Line	:	1156 LIBERTY AVENUE
Second Line	:
City	:	HILLSIDE
State	:	NJ
Zip	:	07205-0000
Country	:	US
Telephone Number	:	908-351-1626
Fax Number	:

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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