Healthcare Provider Details

I. General information

NPI: 1558690248
Provider Name (Legal Business Name): ROBERTS MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 12/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2417 RICHMOND RD
STATEN ISLAND NY
10306-2336
US

IV. Provider business mailing address

30 DUNCAN DR
MORGANVILLE NJ
07751-1649
US

V. Phone/Fax

Practice location:
  • Phone: 732-972-5172
  • Fax: 732-972-5176
Mailing address:
  • Phone: 732-972-5172
  • Fax: 732-972-5176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number112714-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. PATTI MORELLI
Title or Position: OFFICE MGR
Credential:
Phone: 732-972-5172