Healthcare Provider Details

I. General information

NPI: 1093581860
Provider Name (Legal Business Name): ANGELICA ROBLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8403 CUTHBERT RD
KEW GARDENS NY
11415-2140
US

IV. Provider business mailing address

4703 161ST ST
FLUSHING NY
11358-3638
US

V. Phone/Fax

Practice location:
  • Phone: 800-278-0331
  • Fax:
Mailing address:
  • Phone: 929-293-6906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: