=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528023181
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSLYN CHOSAK M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2006
-----------------------------------------------------
Last Update Date | 11/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 CHURCH ST S SUITE 501
-----------------------------------------------------
City | NEW HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06519-1717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-562-5439
-----------------------------------------------------
Fax | 203-624-5157
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 CHURCH ST SOUTH SUITE 501
-----------------------------------------------------
City | NEW HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06519-1717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-562-5439
-----------------------------------------------------
Fax | 203-624-5157
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | 022991
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------