Provider Demographics
NPI:1124282033
Name:LOSOS, ROLAND JERZY (MD)
Entity type:Individual
Prefix:
First Name:ROLAND
Middle Name:JERZY
Last Name:LOSOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-1462
Mailing Address - Country:US
Mailing Address - Phone:201-933-4700
Mailing Address - Fax:
Practice Address - Street 1:155 PARK AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-1462
Practice Address - Country:US
Practice Address - Phone:201-933-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD12634207RG0300X
NJ25MA08993900207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine