Provider Demographics
NPI:1063092112
Name:LOHSE, ROBERT ANTHONY (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ANTHONY
Last Name:LOHSE
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 DUNBAR ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-2122
Mailing Address - Country:US
Mailing Address - Phone:917-566-1561
Mailing Address - Fax:
Practice Address - Street 1:256 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2766
Practice Address - Country:US
Practice Address - Phone:973-743-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF347235363L00000X
NJ26NJ01130600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner