Provider Demographics
NPI:1295482347
Name:ROBERTS, MORGAN PAIGE (RD)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:PAIGE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E 40TH ST APT 32E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1738
Mailing Address - Country:US
Mailing Address - Phone:336-404-1324
Mailing Address - Fax:
Practice Address - Street 1:250 E 40TH ST APT 32E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1738
Practice Address - Country:US
Practice Address - Phone:336-404-1324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered