Provider Demographics
NPI:1053405530
Name:ROBERT MARSICO INC.
Entity type:Organization
Organization Name:ROBERT MARSICO INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSICO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ED D
Authorized Official - Phone:609-652-3774
Mailing Address - Street 1:408 CHRIS GAUPP DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4489
Mailing Address - Country:US
Mailing Address - Phone:609-652-3774
Mailing Address - Fax:609-652-3776
Practice Address - Street 1:408 CHRIS GAUPP DR
Practice Address - Street 2:SUITE 200
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4489
Practice Address - Country:US
Practice Address - Phone:609-652-3774
Practice Address - Fax:609-652-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00842100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ074096Medicare PIN