Provider Demographics
NPI:1891044145
Name:ROSTOVSKY MEDICAL PRACTICE P.C.
Entity type:Organization
Organization Name:ROSTOVSKY MEDICAL PRACTICE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSTOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-238-0266
Mailing Address - Street 1:203 WEST 87TH STREET
Mailing Address - Street 2:SUITE 21
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-0000
Mailing Address - Country:US
Mailing Address - Phone:646-238-0266
Mailing Address - Fax:718-360-5366
Practice Address - Street 1:203 WEST 87TH STREET
Practice Address - Street 2:SUITE 21
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-0000
Practice Address - Country:US
Practice Address - Phone:646-238-0266
Practice Address - Fax:718-360-5366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238524207R00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty