Provider Demographics
NPI:1902235377
Name:ROBBINS, MICHAELA (NP)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 STATE RT 17 UNIT 2125
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-2116
Mailing Address - Country:US
Mailing Address - Phone:201-644-6006
Mailing Address - Fax:
Practice Address - Street 1:479 STATE RT 17 UNIT 2125
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-2116
Practice Address - Country:US
Practice Address - Phone:201-644-6006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23NJ14886600363LA2200X
NY307180363LA2200X
NY672270163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse