Provider Demographics
NPI:1265604276
Name:ROBERGEAU, MARJORIE
Entity type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:
Last Name:ROBERGEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3403 AVE K
Mailing Address - Street 2:1 FL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210
Mailing Address - Country:US
Mailing Address - Phone:347-866-5997
Mailing Address - Fax:
Practice Address - Street 1:350 FIFTH AVE SUITE 5115
Practice Address - Street 2:ONWARD HEALTHCARE THE EMPIRE STATE BUILDING
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10118
Practice Address - Country:US
Practice Address - Phone:866-696-8773
Practice Address - Fax:212-928-9545
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0042831224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant