Healthcare Provider Details

I. General information

NPI: 1609287325
Provider Name (Legal Business Name): YEHUDA ROBERTS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24302 NORTHERN BLVD
DOUGLASTON NY
11362-1150
US

IV. Provider business mailing address

8315 LEFFERTS BLVD APT 6L
KEW GARDENS NY
11415-2545
US

V. Phone/Fax

Practice location:
  • Phone: 718-423-6200
  • Fax:
Mailing address:
  • Phone: 216-509-3056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number095684
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: