Provider Demographics
NPI:1417034273
Name:ROCHLIN, JONATHAN MILES (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MILES
Last Name:ROCHLIN
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 1:450 CLARKSON AVENUE, BOX 1228
Mailing Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE, SUNY DOWNSTATE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:450 CLARKSON AVENUE, BOX 1228
Practice Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE, SUNY DOWNSTATE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-245-4790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241351208000000X, 2080P0204X
GA0604972080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics