1619915428 NPI number — MRS. MARY ELLEN ELIZABETH ROBERTS RN, MSN, APNC

Table of content: MRS. MARY ELLEN ELIZABETH ROBERTS RN, MSN, APNC (NPI 1619915428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619915428 NPI number — MRS. MARY ELLEN ELIZABETH ROBERTS RN, MSN, APNC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTS
Provider First Name:
MARY ELLEN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, MSN, APNC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619915428
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 MEADOWBROOK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHORT HILLS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07078-3316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-751-7322
Provider Business Mailing Address Fax Number:
973-759-3702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36 NEWARK AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
BELLEVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07109-4119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-751-7322
Provider Business Practice Location Address Fax Number:
973-759-3702
Provider Enumeration Date:
06/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  26NN067758 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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