Healthcare Provider Details

I. General information

NPI: 1881917169
Provider Name (Legal Business Name): STEPHEN J ROBERTS CRNA, APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GREAT MEADOW RD STE 208
WETHERSFIELD CT
06109-2355
US

IV. Provider business mailing address

68 SOUTH SERVICE ROAD SUITE 350
MELVILLE NY
11747
US

V. Phone/Fax

Practice location:
  • Phone: 860-573-0700
  • Fax:
Mailing address:
  • Phone: 516-945-3347
  • Fax: 516-945-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number004307
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: