MEDICARE: IESHA ROBERTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	11128	NY

General Provider Information

NPI Number	:	1508730912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IESHA ROBERTS

Provider Business Mailing Address
First Line	:	898 BRYANT AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10474-4728
Country	:	US
Telephone Number	:	646-875-2596
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 PAVONIA AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-2920
Country	:	US
Telephone Number	:	833-671-9527
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2025
Last Update Date	:	09/30/2025

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Directions to “ IESHA ROBERTS ” Practice Location

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