Provider Demographics
NPI:1437227360
Name:ROSKY, LEE PAUL (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:PAUL
Last Name:ROSKY
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 1:3205 FIRE ROAD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5857
Mailing Address - Country:US
Mailing Address - Phone:609-407-1220
Mailing Address - Fax:609-407-7149
Practice Address - Street 1:3205 FIRE ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5857
Practice Address - Country:US
Practice Address - Phone:609-407-1220
Practice Address - Fax:609-407-7149
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA01893500207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1315005Medicaid
NJ195918AUBMedicare ID - Type Unspecified
NJ1315005Medicaid