=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801862271
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAMERON K ROKHSAR M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2006
-----------------------------------------------------
Last Update Date | 09/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 328 E 75TH ST SUITE A
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-3317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-285-1110
-----------------------------------------------------
Fax | 516-512-7617
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 121 E 60TH ST STE 8AB
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-1117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-285-1110
-----------------------------------------------------
Fax | 516-512-7617
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 214852
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------