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General NPI Number Information
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NPI Number | 1205137783
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Entity Type | Organization
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Legal Business Name | ROSLYN CHOSAK M.D.,L.L.C.
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Dates
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Enumeration Date | 11/15/2010
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Last Update Date | 11/15/2010
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Provider Practice Location Address
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Address Line | 2 CHURCH ST S SUITE 501
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City | NEW HAVEN
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State | CT
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Zip | 06519-1717
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Country | US
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Telephone | 203-562-5439
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Fax | 203-624-5157
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Provider Business Mailing Address
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Address Line | 2 CHURCH STREET SOUTH SUITE 501
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City | NEW HAVEN
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State | CT
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Zip | 06519
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Country | US
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Telephone | 203-562-5439
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Fax | 203-624-5157
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROSLYN CHOSAK
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Credential | M.D.
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Telephone | 203-562-5439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 022991
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License Number State | CT
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