Provider Demographics
NPI:1538188867
Name:MONAHAN, ROBERT MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:MONAHAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1067 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6329
Mailing Address - Country:US
Mailing Address - Phone:201-886-8184
Mailing Address - Fax:201-886-8483
Practice Address - Street 1:1067 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6329
Practice Address - Country:US
Practice Address - Phone:201-886-8184
Practice Address - Fax:201-886-8483
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC03317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU02558Medicare UPIN
NJ566239Medicare ID - Type UnspecifiedMEDICARE NUMBER