Healthcare Provider Details

I. General information

NPI: 1104938133
Provider Name (Legal Business Name): ELLIOTT ROSCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N BROADWAY
YONKERS NY
10701-1303
US

IV. Provider business mailing address

1010 N BROADWAY
YONKERS NY
10701-1303
US

V. Phone/Fax

Practice location:
  • Phone: 914-968-3535
  • Fax: 914-968-3566
Mailing address:
  • Phone: 914-968-3535
  • Fax: 914-968-3566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number147103
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number147103
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: