Provider Demographics
NPI:1508827379
Name:MAY, ROBERTA R (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:R
Last Name:MAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:M
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1 E. NEW YORK AVENUE
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244
Mailing Address - Country:US
Mailing Address - Phone:609-653-3519
Mailing Address - Fax:609-653-3247
Practice Address - Street 1:1 E NEW YORK AVENUE
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244
Practice Address - Country:US
Practice Address - Phone:609-653-3519
Practice Address - Fax:609-653-3247
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07258400207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8916209Medicaid
H60542Medicare UPIN
NJ057526Medicare ID - Type Unspecified