Healthcare Provider Details

I. General information

NPI: 1831272830
Provider Name (Legal Business Name): KIRSTEN ROBERTS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S BLDG 8, RM 1B-158
BRONX NY
10461-1138
US

IV. Provider business mailing address

145 W 79TH ST APT 10B
NEW YORK NY
10024-6407
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-4084
  • Fax: 718-918-4580
Mailing address:
  • Phone: 212-580-4907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number203839
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: