Susan Peterson Roberson, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

F301322-1 Issued in NY

Practice address

999 Jamaica Ave
Room 167 SBHC
Brooklyn, NY 11208

Phone

(718) 235-1087

Fax

(718) 235-1291

NPI assigned

Apr 24, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Susan Peterson Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• North Shore-Lij Medical PC

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  • NPI 1053688572
  NPD (past)

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460592000000",
    "number": "1376762062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 LAKEVILLE RD",
            "address_2": "ADOLESCENT MEDICINE SUITE 109",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110421101",
            "telephone_number": "718-235-1087",
            "fax_number": "718-235-1291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "999 JAMAICA AVE",
            "address_2": "ROOM 167 SBHC",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11208",
            "telephone_number": "718-235-1087",
            "fax_number": "718-235-1291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON ROBERSON",
        "first_name": "SUSAN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-24",
        "last_updated": "2016-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "307413-1",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F301322-1",
            "primary": true
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "NY",
            "license": "F390021-1",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "PETERSON",
            "credential": "NP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• David Petersen, NP
• Hayley Petersen, NP
• Madison Petersil, RN
• Lisa M Petersilia, LCSW
• Aubrey Rose Peterson Hague, PA-C
• Barbara Peterson Jr., DDS
• Christian B Peterson
• Deborah Peterson, TSHH
• Eric Dunham Peterson, LCSW
• Hannah Peterson, OTD/R

• Adult Health Nurse Practitioner in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2016; 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.