Provider Demographics
NPI:1619915428
Name:ROBERTS, MARY ELLEN ELIZABETH (RN, MSN, APNC)
Entity Type:Individual
Prefix:MRS
First Name:MARY ELLEN
Middle Name:ELIZABETH
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RN, MSN, APNC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-3316
Mailing Address - Country:US
Mailing Address - Phone:973-751-7322
Mailing Address - Fax:973-759-3702
Practice Address - Street 1:36 NEWARK AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-4119
Practice Address - Country:US
Practice Address - Phone:973-751-7322
Practice Address - Fax:973-759-3702
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NN067758363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ003027BWPMedicare ID - Type Unspecified