Provider Demographics
NPI:1033417332
Name:ROBERTSON, CAROLINE (MAC)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-6041
Mailing Address - Country:US
Mailing Address - Phone:315-343-6939
Mailing Address - Fax:315-343-6939
Practice Address - Street 1:233 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-6041
Practice Address - Country:US
Practice Address - Phone:315-343-6939
Practice Address - Fax:315-343-6939
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000652171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist