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General NPI Number Information
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NPI Number | 1679285019
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Entity Type | Organization
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Legal Business Name | ROSSVILLE PROFESSIONAL MEDICAL SERVICES OF NEW YORK LLC
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Dates
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Enumeration Date | 12/16/2022
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Last Update Date | 12/16/2022
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Provider Practice Location Address
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Address Line | 1974 1ST AVE STE 1
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City | NEW YORK
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State | NY
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Zip | 10029-6430
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Country | US
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Telephone | 847-593-8460
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 32
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City | NORTHBROOK
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State | IL
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Zip | 60065-0032
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | YAN KATSNELSON
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Credential |
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Telephone | 847-593-8460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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