Provider Demographics
NPI:1528135258
Name:ROBERTSON, JOY GRASETA (M D)
Entity type:Individual
Prefix:DR
First Name:JOY
Middle Name:GRASETA
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 ELLIOT STREET
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-5415
Mailing Address - Country:US
Mailing Address - Phone:973-779-8466
Mailing Address - Fax:
Practice Address - Street 1:EAST ORANGE GENERAL HOSPITAL 33 EVERGREEN PLACE
Practice Address - Street 2:2ND FLOOR CAPS PROGRAM
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2166
Practice Address - Country:US
Practice Address - Phone:973-414-6740
Practice Address - Fax:973-414-6730
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA578082084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5328209Medicaid
F40289Medicare UPIN
NJ5328209Medicaid