Provider Demographics
NPI:1245071521
Name:ROBERTS, MELANIE RAE (CGC)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:RAE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 NAGLE AVE APT 5C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-1484
Mailing Address - Country:US
Mailing Address - Phone:801-699-6415
Mailing Address - Fax:
Practice Address - Street 1:221 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4640
Practice Address - Country:US
Practice Address - Phone:646-754-1314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MJ00013300170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS