Healthcare Provider Details

I. General information

NPI: 1295963429
Provider Name (Legal Business Name): BRIAN ALEXANDER ROSSY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 AVE HOSTOS
PONCE PR
00734
US

IV. Provider business mailing address

MANSION REAL 515 CALLE CASTILLA
COTO LAUREL PR
00780-2635
US

V. Phone/Fax

Practice location:
  • Phone: 787-843-9393
  • Fax:
Mailing address:
  • Phone: 787-245-4696
  • Fax: 787-840-0169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18390
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: