Provider Demographics
NPI:1083904494
Name:ROBERTS, AMY L (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RPA-C
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Other - First Name:
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Mailing Address - Street 1:627 BROADWAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5031
Mailing Address - Country:US
Mailing Address - Phone:516-308-4040
Mailing Address - Fax:516-804-6386
Practice Address - Street 1:627 BROADWAY
Practice Address - Street 2:SUITE 1
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5031
Practice Address - Country:US
Practice Address - Phone:516-308-4040
Practice Address - Fax:516-804-6386
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY014615-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant