Provider Demographics
NPI:1447369145
Name:KORNHABER, ROBERT CHARLES (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHARLES
Last Name:KORNHABER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 MAIN ST
Mailing Address - Street 2:SUITE 22
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1161
Mailing Address - Country:US
Mailing Address - Phone:973-376-6062
Mailing Address - Fax:201-944-4004
Practice Address - Street 1:206 MAIN ST
Practice Address - Street 2:SUITE 22
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1161
Practice Address - Country:US
Practice Address - Phone:973-376-6062
Practice Address - Fax:201-944-4004
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2012-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100106700103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ118669Medicare ID - Type Unspecified