Provider Demographics
NPI:1831473099
Name:ROBERTS, MELADIE (LAC)
Entity Type:Individual
Prefix:
First Name:MELADIE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LEXINGTON AVE
Mailing Address - Street 2:LL3
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2935
Mailing Address - Country:US
Mailing Address - Phone:917-687-9945
Mailing Address - Fax:
Practice Address - Street 1:50 LEXINGTON AVE
Practice Address - Street 2:LL3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2935
Practice Address - Country:US
Practice Address - Phone:917-687-9945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4261171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist