Provider Demographics
NPI:1871920322
Name:ROBERT B THORNE MD PLLC
Entity type:Organization
Organization Name:ROBERT B THORNE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:THORNE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:201-210-8235
Mailing Address - Street 1:1625 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-6302
Mailing Address - Country:US
Mailing Address - Phone:201-210-8235
Mailing Address - Fax:
Practice Address - Street 1:1625 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-6302
Practice Address - Country:US
Practice Address - Phone:201-210-8235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03992200207R00000X
NY161429-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ121861OtherMEDICARE ID
NY14X071OtherMEDICARE ID- TYPE UNSPECIFIED
PA121861OtherMEDICARE ID- TYPE UNSPECIFIED
PA121861OtherMEDICARE ID- TYPE UNSPECIFIED