Provider Demographics
NPI:1194012856
Name:ROBERTS, LATOYA (DO)
Entity type:Individual
Prefix:MS
First Name:LATOYA
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LATOYA
Other - Middle Name:
Other - Last Name:KHALIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1925 PACIFIC AVE FL 8
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-6713
Mailing Address - Country:US
Mailing Address - Phone:609-441-8146
Mailing Address - Fax:609-442-8002
Practice Address - Street 1:1925 PACIFIC AVE FL 8
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-6713
Practice Address - Country:US
Practice Address - Phone:609-441-8146
Practice Address - Fax:609-442-8002
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10616300207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0743151Medicaid