Healthcare Provider Details

I. General information

NPI: 1780756940
Provider Name (Legal Business Name): BENJAMIN ROKHSAR DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CUTTERMILL ROAD 127
GREAT NECK NY
11021
US

IV. Provider business mailing address

15 CUTTERMILL ROAD 127
GREAT NECK NY
11021
US

V. Phone/Fax

Practice location:
  • Phone: 516-967-1116
  • Fax:
Mailing address:
  • Phone: 516-967-1116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN0049541
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: