Healthcare Provider Details

I. General information

NPI: 1912333857
Provider Name (Legal Business Name): MARYANN B. ROIK MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 HIGH RIDGE RD
STAMFORD CT
06905-3018
US

IV. Provider business mailing address

PO BOX 201
LINCROFT NJ
07738-0201
US

V. Phone/Fax

Practice location:
  • Phone: 203-977-5303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number005691
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: