Healthcare Provider Details

I. General information

NPI: 1063710390
Provider Name (Legal Business Name): ROSH OB-GYN ULTRASOUND PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 LEXINGTON AVE FRNT 1A
NEW YORK NY
10065-5987
US

IV. Provider business mailing address

PO BOX 645981
CINCINNATI OH
45264-5981
US

V. Phone/Fax

Practice location:
  • Phone: 212-249-3949
  • Fax: 718-253-2333
Mailing address:
  • Phone: 212-725-0123
  • Fax: 718-253-2333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL F. ROSHAN
Title or Position: PRACTICE OWNER
Credential: MD
Phone: 212-725-0123