Physician Compare National (NPI:1831412949)

HEALTHCARE PROVIDER: JENNIFER ROBERTSON

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1831412949
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8426380585
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20191023001367
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ROBERTSON
	Individual professional last name
Provider First Name	JENNIFER
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2007
	Individual professional's medical school graduation year
Primary Specialty	QUALIFIED SPEECH LANGUAGE PATHOLOGIST
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	THE SHIELD OF DAVID, INC.
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	2264472026
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	15
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	3909 214TH PL
	Group Practice or individual's line 1 address
City	BAYSIDE
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	113612123
	Group Practice or individual's zip code (9 digits when available)
Phone Number	71822957572289
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y