Provider Demographics
NPI:1316145790
Name:FLAHERTY, ROBERT J (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:FLAHERTY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WASHINGTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-2626
Mailing Address - Country:US
Mailing Address - Phone:973-377-0782
Mailing Address - Fax:
Practice Address - Street 1:1015 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1413
Practice Address - Country:US
Practice Address - Phone:973-334-9019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00389200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL706243Medicare PIN