Provider Demographics
NPI:1912115791
Name:THORNE, ROBERT BRUCE JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRUCE
Last Name:THORNE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7000 KENNEDY BLVD E APT 21E
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-4836
Mailing Address - Country:US
Mailing Address - Phone:201-210-8235
Mailing Address - Fax:201-210-8235
Practice Address - Street 1:7000 KENNEDY BLVD EAST
Practice Address - Street 2:APT 21E
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-4836
Practice Address - Country:US
Practice Address - Phone:201-210-8235
Practice Address - Fax:201-210-8235
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1614292081H0002X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ121861Medicare ID - Type UnspecifiedNJ AND PA MEDICARE
NY14X071Medicare ID - Type UnspecifiedNEW YORK MEDICARE
NJD77641Medicare UPIN