Provider Demographics
NPI:1609816792
Name:ROBERTS, NIKKI L (MD)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MOUNT KISCO MEDICAL GROUP, PC
Mailing Address - Street 2:90 SOUTH BEDFORD ROAD
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3412
Mailing Address - Country:US
Mailing Address - Phone:914-241-1050
Mailing Address - Fax:914-242-1516
Practice Address - Street 1:2507 SOUTH ROAD
Practice Address - Street 2:MOUNT KISCO MEDICAL GROUP, PC
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-471-2287
Practice Address - Fax:845-471-2580
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY231015207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02600540Medicaid
NYI12898Medicare UPIN
NY02600540Medicaid