Provider Demographics
NPI:1306217971
Name:67TH STREET OB GYN PLLC
Entity Type:Organization
Organization Name:67TH STREET OB GYN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-249-3949
Mailing Address - Street 1:PO BOX 645990
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-5990
Mailing Address - Country:US
Mailing Address - Phone:212-249-3949
Mailing Address - Fax:212-249-3916
Practice Address - Street 1:115 E 67TH ST APT 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-5990
Practice Address - Country:US
Practice Address - Phone:212-249-3949
Practice Address - Fax:312-602-9799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty