Provider Demographics
NPI:1407117393
Name:BLOCK, ROBERTA (MSED)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:BLOCK
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:
Other - Last Name:SHEINMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:3516 HOWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-5155
Mailing Address - Country:US
Mailing Address - Phone:516-379-3416
Mailing Address - Fax:
Practice Address - Street 1:3516 HOWARD BLVD
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-5155
Practice Address - Country:US
Practice Address - Phone:516-379-3416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist