Provider Demographics
NPI:1083937460
Name:JAVIER, ROBERTO (NP)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:JAVIER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 UTOPIA PKWY
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3331
Mailing Address - Country:US
Mailing Address - Phone:347-368-4119
Mailing Address - Fax:
Practice Address - Street 1:4520 UTOPIA PKWY
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3331
Practice Address - Country:US
Practice Address - Phone:347-368-4119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY574249163W00000X
NY308857363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse