Healthcare Provider Details

I. General information

NPI: 1417034273
Provider Name (Legal Business Name): JONATHAN MILES ROCHLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVENUE, BOX 1228 DEPARTMENT OF EMERGENCY MEDICINE, SUNY DOWNSTATE
BROOKLYN NY
11203
US

IV. Provider business mailing address

450 CLARKSON AVENUE, BOX 1228 DEPARTMENT OF EMERGENCY MEDICINE, SUNY DOWNSTATE
BROOKLYN NY
11203
US

V. Phone/Fax

Practice location:
  • Phone: 718-245-4790
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number241351
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number060497
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number241351
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: