Individual
ROBERT GLENN FORTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
503 CRANBURY RD, EAST BRUNSWICK, NJ 08816-3612
(732) 390-8400
(732) 390-8970
Mailing address
503 CRANBURY RD, EAST BRUNSWICK, NJ 08816-3612
(732) 390-8400
(732) 390-8970
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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