Basic Information
| Provider Information | |||||||||
| NPI: | 1457621625 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RICHARD I ROBERTS MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 NORTHERN BLVD | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110215206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164664128 | ||||||||
| FaxNumber: | 5164821822 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 NORTHERN BLVD | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110215206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164664128 | ||||||||
| FaxNumber: | 5164821822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2012 | ||||||||
| LastUpdateDate: | 05/16/2012 | ||||||||
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| AuthorizedOfficialLastName: | ROBERTS | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5164664128 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.