Provider Demographics
NPI:1982795241
Name:HOLE, ROBERT LIONEL III (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LIONEL
Last Name:HOLE
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:1360 CLIFTON AVENUE
Mailing Address - Street 2:STE. #96
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012
Mailing Address - Country:US
Mailing Address - Phone:973-458-0772
Mailing Address - Fax:973-458-0864
Practice Address - Street 1:1011 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3518
Practice Address - Country:US
Practice Address - Phone:973-458-0772
Practice Address - Fax:973-458-0864
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2010-07-30
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Provider Licenses
StateLicense IDTaxonomies
NJMA058929207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223836776OtherTIN
NJ223836776OtherTIN
003687SZ5Medicare PIN