Provider Demographics
NPI:1417083221
Name:MIRTCHEVA-TROCHEVA, ROSNA M
Entity Type:Individual
Prefix:
First Name:ROSNA
Middle Name:M
Last Name:MIRTCHEVA-TROCHEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUSTAVE L. LEVY PLACE
Mailing Address - Street 2:BOX 1194
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6574
Mailing Address - Country:US
Mailing Address - Phone:212-241-8395
Mailing Address - Fax:212-289-0092
Practice Address - Street 1:1000 10TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1147
Practice Address - Country:US
Practice Address - Phone:201-830-3122
Practice Address - Fax:201-200-0838
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228859207U00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9N3500Z241Medicare PIN
NY02868880Medicaid
NY9N350R7502Medicare PIN
NY9N3501L821Medicare PIN
NY9N3501L822Medicare PIN
NY9N350R7503Medicare PIN