Basic Information
| Provider Information | |||||||||
| NPI: | 1871670216 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUBESHTER | ||||||||
| FirstName: | ROBERTA | ||||||||
| MiddleName: | |||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 SOUTH AVE | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146202733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853416732 | ||||||||
| FaxNumber: | 5853418381 | ||||||||
| Practice Location | |||||||||
| Address1: | 905 CULVER RD | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146097141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853416732 | ||||||||
| FaxNumber: | 5856418381 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | 000763 | NY | Y | Other Service Providers | Midwife |
ID Information
| ID | Type | State | Issuer | Description | 01894619 | 05 | NY | MEDICAID |