Provider Demographics
NPI:1427162742
Name:LOCKO, ROBERTA (M D)
Entity type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:
Last Name:LOCKO
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 1:506 MALCOLM X BLVD
Mailing Address - Street 2:WP 522
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-1802
Mailing Address - Country:US
Mailing Address - Phone:212-939-2740
Mailing Address - Fax:212-939-2759
Practice Address - Street 1:506 MALCOLM X BLVD
Practice Address - Street 2:WP 522
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1802
Practice Address - Country:US
Practice Address - Phone:212-939-2740
Practice Address - Fax:212-939-2759
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1300522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY37E171Medicare ID - Type Unspecified
NYD91643Medicare UPIN