Provider Demographics
NPI:1639408305
Name:ROBERTS MEDICAL PC
Entity Type:Organization
Organization Name:ROBERTS MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEPT
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALLONIS
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 1:2035 RALPH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5300
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:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112714-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY662181Medicare PIN