Provider Demographics
NPI:1134194954
Name:ROBERSON, MEIKA TYLESE (MD)
Entity type:Individual
Prefix:DR
First Name:MEIKA
Middle Name:TYLESE
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MEIKA
Other - Middle Name:
Other - Last Name:NEBLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 GUSTAVE LEVY PLACE
Mailing Address - Street 2:BOX 1149
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:212-241-0101
Mailing Address - Fax:212-426-5083
Practice Address - Street 1:100TH ST AND MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-241-0101
Practice Address - Fax:212-426-5083
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224128207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02312509Medicaid
P00194544OtherRAILROAD
P00265527OtherRAILROAD
NY02312509Medicaid
NY0421ALMedicare PIN
NY2019Q1Medicare ID - Type Unspecified