MEDICARE: DR. JONATHAN MILES ROCHLIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	241351	NY
2	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	060497	GA
3	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	241351	NY

General Provider Information

NPI Number	:	1417034273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN MILES ROCHLIN M.D.

Provider Business Mailing Address
First Line	:	450 CLARKSON AVENUE, BOX 1228
Second Line	:	DEPARTMENT OF EMERGENCY MEDICINE, SUNY DOWNSTATE
City	:	BROOKLYN
State	:	NY
Zip	:	11203
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 CLARKSON AVENUE, BOX 1228
Second Line	:	DEPARTMENT OF EMERGENCY MEDICINE, SUNY DOWNSTATE
City	:	BROOKLYN
State	:	NY
Zip	:	11203
Country	:	US
Telephone Number	:	718-245-4790
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	09/15/2011

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