1205332624 NPI number — DR. MICHAEL GIANCARLO ROSCO MD

Table of content: DR. MICHAEL GIANCARLO ROSCO MD (NPI 1205332624)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205332624 NPI number — DR. MICHAEL GIANCARLO ROSCO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSCO
Provider First Name:
MICHAEL
Provider Middle Name:
GIANCARLO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205332624
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 NICOLLS ROAD
Provider Second Line Business Mailing Address:
HSC LEVEL 4, ROOM 176
Provider Business Mailing Address City Name:
STONY BROOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11794-8430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-638-8517
Provider Business Mailing Address Fax Number:
631-638-0069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 NICOLLS ROAD
Provider Second Line Business Practice Location Address:
HSC LEVEL 4, ROOM 176
Provider Business Practice Location Address City Name:
STONY BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11794-8430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-638-8517
Provider Business Practice Location Address Fax Number:
631-638-0069
Provider Enumeration Date:
04/04/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com