Healthcare Provider Details

I. General information

NPI: 1851474696
Provider Name (Legal Business Name): ADAM ROBERTS RPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N. VILLAGE
ROCKVILLE CENTRE NY
11571
US

IV. Provider business mailing address

P.O BOX 798 ATTN: PHYSICIAN BILLING
ROCKVILLE CENTRE NY
11571
US

V. Phone/Fax

Practice location:
  • Phone: 516-705-1353
  • Fax:
Mailing address:
  • Phone: 516-705-1353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number007450
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: