Healthcare Provider Details

I. General information

NPI: 1013444637
Provider Name (Legal Business Name): PEGGY ESTIME ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PEGGY ANN ROBERTS NURSE PRACTITIONER

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27005 76TH AVE STE 457A
NEW HYDE PARK NY
11040-1402
US

IV. Provider business mailing address

27005 76TH AVE STE 457A
NEW HYDE PARK NY
11040-1402
US

V. Phone/Fax

Practice location:
  • Phone: 347-287-1375
  • Fax:
Mailing address:
  • Phone: 347-287-1375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number639989-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number421288
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: