Healthcare Provider Details

I. General information

NPI: 1669708582
Provider Name (Legal Business Name): ROSH MATERNAL FETAL MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 MADISON AVE
NEW YORK NY
10016-3814
US

IV. Provider business mailing address

PO BOX 645977
CINCINNATI OH
45264-5977
US

V. Phone/Fax

Practice location:
  • Phone: 212-249-3949
  • Fax: 312-602-9799
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: PRESIDENT
Credential: M.D.
Phone: 212-725-0123