Provider Demographics
NPI:1245395458
Name:ROSHWALB, GUR-ARYE YEHUDA (MD)
Entity Type:Individual
Prefix:DR
First Name:GUR-ARYE
Middle Name:YEHUDA
Last Name:ROSHWALB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GUR
Other - Middle Name:
Other - Last Name:ROSHWALB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:634 WEST 256TH STREET
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471
Mailing Address - Country:US
Mailing Address - Phone:917-806-5432
Mailing Address - Fax:645-843-9352
Practice Address - Street 1:600 W 246TH ST
Practice Address - Street 2:#511
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-3611
Practice Address - Country:US
Practice Address - Phone:212-284-9314
Practice Address - Fax:928-222-3250
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201230207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine