Healthcare Provider Details

I. General information

NPI: 1902080971
Provider Name (Legal Business Name): DRG MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1454 HYLAN BLVD
STATEN ISLAND NY
10305-1923
US

IV. Provider business mailing address

333 E 69TH ST SUITE TH8
BROOKLYN NY
11234
US

V. Phone/Fax

Practice location:
  • Phone: 718-236-1056
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number001453
License Number State

VIII. Authorized Official

Name: DR. DIMA ROZEN
Title or Position: MD
Credential: MD
Phone: 718-236-1056