MEDICARE: DR. ROBERT J ROSTAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	031352	NY

General Provider Information

NPI Number	:	1215196688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT J ROSTAN DDS

Provider Business Mailing Address
First Line	:	433 NEWBRIDGE RD
Second Line	:
City	:	EAST MEADOW
State	:	NY
Zip	:	11554-4120
Country	:	US
Telephone Number	:	516-785-4013
Fax Number	:

Provider Business Practice Location Address
First Line	:	433 NEWBRIDGE RD
Second Line	:
City	:	EAST MEADOW
State	:	NY
Zip	:	11554-4120
Country	:	US
Telephone Number	:	516-785-4013
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2008
Last Update Date	:	06/02/2008

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