Provider Demographics
NPI:1346224441
Name:ROSERO, HUGO (MD)
Entity Type:Individual
Prefix:
First Name:HUGO
Middle Name:
Last Name:ROSERO
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:PO BOX 95000-2449
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2449
Mailing Address - Country:US
Mailing Address - Phone:212-420-2584
Mailing Address - Fax:212-420-2330
Practice Address - Street 1:317 E 17TH ST
Practice Address - Street 2:11 FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3804
Practice Address - Country:US
Practice Address - Phone:212-420-2584
Practice Address - Fax:212-420-2330
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1776311207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01230079Medicaid
NY01230079Medicaid
NY75F601Medicare ID - Type Unspecified