Basic Information
| Provider Information | |||||||||
| NPI: | 1174725477 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONKLING | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | F. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 604 | ||||||||
| Address2: | |||||||||
| City: | MANASQUAN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2023208834 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2401 ALGONKIN TRAIL | ||||||||
| Address2: | |||||||||
| City: | MANASQUAN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2023208834 | ||||||||
| FaxNumber: | 4343858616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 09/26/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101058846 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QG0300X | 25MA05135400 | NJ | N | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | 208D00000X | 25MA05135400 | NJ | N | Allopathic & Osteopathic Physicians | General Practice | 207QA0505X | 25MA05135400 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
No ID Information.