Basic Information
| Provider Information | |||||||||
| NPI: | 1932102589 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DESIMONE | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 508 | ||||||||
| Address2: | |||||||||
| City: | MONTVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070450508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738862195 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 254 COLUMBIA TPKE | ||||||||
| Address2: | |||||||||
| City: | FLORHAM PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079321222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736256000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2005 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | ME113643 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 25MA05633700 | NJ | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 6503501 | 05 | NJ | MEDICAID |