Healthcare Provider Details

I. General information

NPI: 1487746426
Provider Name (Legal Business Name): YOUSEF ROKHSAR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSEPH ROKHSAR DDS

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100-11 67TH RD SUITE #123
FOREST HILLS NY
11375
US

IV. Provider business mailing address

100-11 67TH RD SUITE #123
FOREST HILLS NY
11375
US

V. Phone/Fax

Practice location:
  • Phone: 718-897-5391
  • Fax: 718-897-5391
Mailing address:
  • Phone: 718-897-5391
  • Fax: 718-897-5391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number27840
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: