Provider Demographics
NPI:1134305311
Name:ROSARION, RANDOLPH (MD)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:
Last Name:ROSARION
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 1:12010 15TH AVE
Mailing Address - Street 2:RM. 6
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-1617
Mailing Address - Country:US
Mailing Address - Phone:718-701-5949
Mailing Address - Fax:718-701-5949
Practice Address - Street 1:12010 15TH AVE
Practice Address - Street 2:RM. 6
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11356-1617
Practice Address - Country:US
Practice Address - Phone:718-701-5949
Practice Address - Fax:718-701-5949
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201787208100000X, 208VP0000X, 204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1865684OtherUNITED HEALTHCARE
NY201787-NYOther1199
NY20178701OtherNEIGHBORHOOD
NY01902914Medicaid
NY1307J2OtherEMPIRE BC/BS PPO
NY201787OtherMETROPLUS
NYRR1787OtherATLANTIS
NY11303OtherMAGNACARE
NY5158655OtherAETNA
NY1444783OtherFIRST HEATH/COVENTRY
NY9764439OtherCIGNA
NYP3652400OtherOXFORD FREEDOM
NYRR118757OtherGHI PPO
NY4C1004OtherHEALTHNET
NY01215142OtherAMERIGROUP
NY20178701OtherNEIGHBORHOOD
NY5158655OtherAETNA
NY8T9111Medicare PIN