Healthcare Provider Details

I. General information

NPI: 1578667788
Provider Name (Legal Business Name): JULES H ROBERTS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 OLD COUNTRY ROAD
PLAINVIEW NY
11803
US

IV. Provider business mailing address

901 OLD COUNTRY ROAD
PLAINVIEW NY
11803
US

V. Phone/Fax

Practice location:
  • Phone: 516-681-5330
  • Fax: 516-681-9315
Mailing address:
  • Phone: 516-681-5330
  • Fax: 516-681-9315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number021197
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier99376967
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: