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General NPI Number Information
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NPI Number | 1770144040
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Entity Type | Individual
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Provider Name | KEVIN ROSSTIN MD, FACS
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Gender | Male
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Dates
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Enumeration Date | 06/26/2019
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 113 E 39TH ST
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City | NEW YORK
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State | NY
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Zip | 10016-0968
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Country | US
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Telephone | 212-466-6040
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Fax |
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Provider Business Mailing Address
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Address Line | 1160 PINES LAKE DR W
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City | WAYNE
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State | NJ
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Zip | 07470-6112
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Country | US
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Telephone | 212-466-6040
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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 | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 307034
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License Number State | NY
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