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Individual
ROBERT GLENN FORTIN
Active
Individual
ROBERT GLENN FORTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
MA055583
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1545372
UNITED ID
NJ
01
—
222694202
TAX ID
NJ
01
—
8222069
QUALCARE/GHI NY ID
NJ
01
—
F06244
HEALTHNET ID
NJ
01
—
MA055583
HIP/PHCS ID
NJ
01
—
P2676733
OXFORD ID
NJ
Enumeration date
03/17/2006
Last updated
03/15/2017
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