Healthcare Provider Details

I. General information

NPI: 1982047528
Provider Name (Legal Business Name): ROSHAN GIVERGIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2013
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 SAINT RAYMONDS AVE
BRONX NY
10461-3124
US

IV. Provider business mailing address

2475 SAINT RAYMONDS AVE
BRONX NY
10461-3124
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4321
  • Fax:
Mailing address:
  • Phone: 718-920-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number282328
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: