Healthcare Provider Details

I. General information

NPI: 1265604276
Provider Name (Legal Business Name): MS. MARJORIE ROBERGEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 FIFTH AVE SUITE 5115 ONWARD HEALTHCARE THE EMPIRE STATE BUILDING
NEW YORK NY
10118
US

IV. Provider business mailing address

3403 AVE K 1 FL
BROOKLYN NY
11210
US

V. Phone/Fax

Practice location:
  • Phone: 866-696-8773
  • Fax: 212-928-9545
Mailing address:
  • Phone: 347-866-5997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0042831
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: