Healthcare Provider Details

I. General information

NPI: 1073162343
Provider Name (Legal Business Name): KOFI ROBERTSON MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28-10 JACKSON AVENUE
LONG ISLAND CITY NY
11101
US

IV. Provider business mailing address

28-10 JACKSON AVENUE
LONG ISLAND CITY NY
11101
US

V. Phone/Fax

Practice location:
  • Phone: 908-917-6532
  • Fax:
Mailing address:
  • Phone: 908-917-6532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: NII AMON ROBERTSON
Title or Position: ANESTHESIOLOGIST
Credential: MD
Phone: 908-917-6532