Basic Information
| Provider Information | |||||||||
| NPI: | 1346408747 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARRUCCO | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 ROUTE 73 NORTH, SUITE 201A | ||||||||
| Address2: | 7000 ATRIUM WAY | ||||||||
| City: | MARLTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080533425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568404500 | ||||||||
| FaxNumber: | 8562916819 | ||||||||
| Practice Location | |||||||||
| Address1: | 2309 E EVESHAM RD | ||||||||
| Address2: | SUITES 201 & 202 | ||||||||
| City: | VOORHEES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080431559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563255400 | ||||||||
| FaxNumber: | 8563255416 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2008 | ||||||||
| LastUpdateDate: | 09/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | OS014039 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | 25MB08940100 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 026999 | 05 | NJ | MEDICAID |