Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 25MA05972600 | NJ |
NPI | 1033296504 |
---|---|
Provider Name | Robert Monaco |
First Address | Boston, MA 02241-6457 |
Second Address | Bridgewater, NJ 08807-1746 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 12/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7580908 | (05) | NJ |
G70881 | (02) | NJ |