Healthcare Provider Details

I. General information

NPI: 1730017211
Provider Name (Legal Business Name): ROSHAN JOHN MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE # 50
BROOKLYN NY
11203-2012
US

IV. Provider business mailing address

450 CLARKSON AVE # 50
BROOKLYN NY
11203-2012
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-2408
  • Fax:
Mailing address:
  • Phone: 718-270-2408
  • Fax: 718-270-2408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: