1992709760 NPI number — DR. ROBERT STEPHEN BORETZ MD

Table of content: DR. ROBERT STEPHEN BORETZ MD (NPI 1992709760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992709760 NPI number — DR. ROBERT STEPHEN BORETZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORETZ
Provider First Name:
ROBERT
Provider Middle Name:
STEPHEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992709760
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
762 US HIGHWAY 202/206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGEWATER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08807-1773
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-429-7600
Provider Business Mailing Address Fax Number:
908-429-7960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
762 US HIGHWAY 202/206
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGEWATER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08807-1773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-429-7600
Provider Business Practice Location Address Fax Number:
908-429-7960
Provider Enumeration Date:
06/09/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207XS0106X , with the licence number:  25MA07211900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 841666216 . This is a "TID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".