Provider Demographics
NPI:1063853737
Name:PETER C ROBLEJO MD
Entity type:Organization
Organization Name:PETER C ROBLEJO MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROBLEJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-868-0821
Mailing Address - Street 1:5910 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-2112
Mailing Address - Country:US
Mailing Address - Phone:201-868-0821
Mailing Address - Fax:
Practice Address - Street 1:5910 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-2112
Practice Address - Country:US
Practice Address - Phone:201-868-0821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA070745002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI52539Medicare UPIN