Provider Demographics
NPI:1295063386
Name:ROBERTS, HOLLY HARLAYNE (DO)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:HARLAYNE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 66TH ST
Mailing Address - Street 2:UNIT D 206
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-9175
Mailing Address - Country:US
Mailing Address - Phone:646-808-9140
Mailing Address - Fax:
Practice Address - Street 1:200 E 66TH ST
Practice Address - Street 2:UNIT D 206
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-9175
Practice Address - Country:US
Practice Address - Phone:646-808-9140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106961207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology