Provider Demographics
NPI:1861616203
Name:MILLS, ROBERT D (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:MILLS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 POLY PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7104
Mailing Address - Country:US
Mailing Address - Phone:718-836-6600
Mailing Address - Fax:973-962-0046
Practice Address - Street 1:800 POLY PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7104
Practice Address - Country:US
Practice Address - Phone:718-836-6600
Practice Address - Fax:973-962-0046
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB52808207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJJ37079OtherHEALTHNET
NJ0011698OtherAETNA HMO
NJ4131222OtherAETNA PPO
NJ110050049OtherRAILROAD MEDICARE PIN#
NJPP077OtherOXFORD
NJPP077OtherOXFORD
NJJ37079OtherHEALTHNET