Provider Demographics
NPI:1538142054
Name:BROSS, ROBERT J (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:BROSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:23659 COLUMBUS RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:COLUMBUS
Mailing Address - State:NJ
Mailing Address - Zip Code:08022-1980
Mailing Address - Country:US
Mailing Address - Phone:609-298-3304
Mailing Address - Fax:609-298-7091
Practice Address - Street 1:23659 COLUMBUS RD
Practice Address - Street 2:SUITE 4
Practice Address - City:COLUMBUS
Practice Address - State:NJ
Practice Address - Zip Code:08022-1979
Practice Address - Country:US
Practice Address - Phone:609-298-3304
Practice Address - Fax:609-298-7091
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2022-01-31
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04640000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7681305Medicaid
NJ508348A14Medicare ID - Type Unspecified
NJ7681305Medicaid