Provider Demographics
NPI:1972667970
Name:O'CONNELL, ROBERT F (PT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:F
Last Name:O'CONNELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2333
Mailing Address - Country:US
Mailing Address - Phone:908-687-1830
Mailing Address - Fax:
Practice Address - Street 1:2780 MORRIS AVE
Practice Address - Street 2:STE 1B
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-4852
Practice Address - Country:US
Practice Address - Phone:908-687-1830
Practice Address - Fax:908-687-3680
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00486800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ025246M47Medicare ID - Type Unspecified