Provider Demographics
NPI:1851474696
Name:ROBERTS, ADAM (RPA)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 798
Mailing Address - Street 2:ATTN: PHYSICIAN BILLING
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11571
Mailing Address - Country:US
Mailing Address - Phone:516-705-1353
Mailing Address - Fax:
Practice Address - Street 1:1000 N. VILLAGE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11571
Practice Address - Country:US
Practice Address - Phone:516-705-1353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007450363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5F7601Medicare PIN
NY5F760EH271Medicare PIN