Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MA29876 | NJ |
N | 207QA0401X | Family Doctor - Addiction Medicine | MA29876 | NJ |
NPI | 1063683688 |
---|---|
Provider Name | Dr. Lorraine D Robertson |
First Address | Chester, NJ 07930-2481 |
Second Address | Chester, NJ 07930-2481 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2008 |
Last Update Date | 16/02/2011 |