Healthcare Provider Details

I. General information

NPI: 1184623134
Provider Name (Legal Business Name): ROGER IRA EMERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 04/21/2021
Certification Date: 03/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 MADISON AVE FL 2
NEW YORK NY
10022-3418
US

IV. Provider business mailing address

555 MADISON AVE FL 2
NEW YORK NY
10022-3418
US

V. Phone/Fax

Practice location:
  • Phone: 646-754-2000
  • Fax: 646-754-9690
Mailing address:
  • Phone: 646-754-2000
  • Fax: 646-754-9690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number197044
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: