Provider Demographics
NPI:1528440559
Name:ROKA MAGAR, SWOSTI
Entity type:Individual
Prefix:
First Name:SWOSTI
Middle Name:
Last Name:ROKA MAGAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 GRAND CONCOURSE
Mailing Address - Street 2:#5A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-5524
Mailing Address - Country:US
Mailing Address - Phone:281-777-7994
Mailing Address - Fax:
Practice Address - Street 1:5818 N NEVADA
Practice Address - Street 2:SUITE 225
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918
Practice Address - Country:US
Practice Address - Phone:719-365-3740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODR.0064759207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program