Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 63637 | NJ |
NPI | 1376580415 |
---|---|
Provider Name | Maria Isabel Roberti |
First Address | Summit, NJ 07901-2458 |
Second Address | Livingston, NJ 07039-5672 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 29/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6841503 | (05) | NJ |
G03156 | (02) | NJ |