Provider Demographics
NPI:1558690248
Name:ROBERTS MEDICAL PC
Entity Type:Organization
Organization Name:ROBERTS MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:MORELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-972-5172
Mailing Address - Street 1:30 DUNCAN DR
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1649
Mailing Address - Country:US
Mailing Address - Phone:732-972-5172
Mailing Address - Fax:732-972-5176
Practice Address - Street 1:2417 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2336
Practice Address - Country:US
Practice Address - Phone:732-972-5172
Practice Address - Fax:732-972-5176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112714-1207R00000X
207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY662181Medicare PIN