Stacy Roberts

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

License

712826 Issued in NY

Practice address

22004 Linden Blvd
Cambria Heights, NY 11411-1621

Phone

(718) 712-3358

NPI assigned

Mar 13, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1394668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394668800000",
    "number": "1356767321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1672 RALPH AVE APT 1B",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112363331",
            "telephone_number": "646-509-3705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22004 LINDEN BLVD",
            "city": "CAMBRIA HEIGHTS",
            "state": "NY",
            "postal_code": "114111621",
            "telephone_number": "718-712-3358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "STACY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-03-13",
        "last_updated": "2014-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NY",
            "license": "712826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Early Intervention Provider Agency in Cambria Heights, NY
• Providers in Cambria Heights, NY by specialty
• Early Intervention Provider Agency in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.