Provider Demographics
NPI:1134182876
Name:ROBERTS, LARRY P (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:P
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 MEMORIAL HWY
Mailing Address - Street 2:SUITE 3-2
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804
Mailing Address - Country:US
Mailing Address - Phone:914-235-2929
Mailing Address - Fax:914-235-2945
Practice Address - Street 1:175 MEMORIAL HWY
Practice Address - Street 2:SUITE 3-2
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804
Practice Address - Country:US
Practice Address - Phone:914-235-2929
Practice Address - Fax:914-235-2945
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125886208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00392214Medicaid
NY10A881Medicare ID - Type Unspecified
NY00392214Medicaid