Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 0101058846 | VA |
Y | 207QA0505X | Family Doctor - Adult Medicine | 25MA05135400 | NJ |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 25MA05135400 | NJ |
N | 208D00000X | General Practice Physician | 25MA05135400 | NJ |
NPI | 1174725477 |
---|---|
Provider Name | Robert F. Conkling |
First Address | Manasquan, NJ 08736 |
Second Address | Manasquan, NJ 08736 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 26/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F86315 | (02) | PA |