Provider Demographics
NPI:1396882593
Name:GOGGINS, ROBERT JAMES
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAMES
Last Name:GOGGINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NORTHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4702
Mailing Address - Country:US
Mailing Address - Phone:973-736-9866
Mailing Address - Fax:
Practice Address - Street 1:100 NORTHFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4702
Practice Address - Country:US
Practice Address - Phone:973-736-9866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100116000103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ35S100116000OtherPSYCHOLOGY LIC. NO.
199189Medicare ID - Type Unspecified