Provider Demographics
NPI:1730871245
Name:BAKER, ROBERT MICHAEL
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:BAKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 CENTENNIAL AVE
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-4321
Mailing Address - Country:US
Mailing Address - Phone:732-582-1804
Mailing Address - Fax:732-582-1741
Practice Address - Street 1:1303 CENTENNIAL AVE
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-4321
Practice Address - Country:US
Practice Address - Phone:732-562-1804
Practice Address - Fax:732-562-1741
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00354900156FX1800X
156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician