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General NPI Number Information
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NPI Number | 1669530218
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Entity Type | Individual
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Provider Name | STACY DANA ROSKIN M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 3435 NE 163RD ST
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33160-4426
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Country | US
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Telephone | 786-480-5707
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Fax |
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Provider Business Mailing Address
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Address Line | 3225 NE 167TH ST
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33160-3847
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Country | US
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Telephone | 786-480-5705
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME74069
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME74069
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License Number State | FL
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