Provider Demographics
NPI:1255211454
Name:ROBINSON, GARRY
Entity type:Individual
Prefix:
First Name:GARRY
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 LUMMISTOWN RD
Mailing Address - Street 2:
Mailing Address - City:CEDARVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08311-2221
Mailing Address - Country:US
Mailing Address - Phone:856-357-2818
Mailing Address - Fax:
Practice Address - Street 1:785 W SHERMAN AVE FL 1
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6913
Practice Address - Country:US
Practice Address - Phone:856-451-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ153697000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily