Provider Demographics
NPI:1295914430
Name:ROBERTSON, MICHELLE WILLIAMS (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:WILLIAMS
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:YOLANDA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:170 FRELINGHUYSEN RD
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-8020
Mailing Address - Country:US
Mailing Address - Phone:732-445-0123
Mailing Address - Fax:
Practice Address - Street 1:170 FRELINGHUYSEN RD
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-8020
Practice Address - Country:US
Practice Address - Phone:732-445-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07513600207Q00000X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9043403Medicaid
NJ9043403Medicaid
NJ199463BZJMedicare PIN