Provider Demographics
NPI:1467763177
Name:JAMES S. ROSOKOFF, M.D., P.C.
Entity Type:Organization
Organization Name:JAMES S. ROSOKOFF, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:ROSOKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-659-2779
Mailing Address - Street 1:15 CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2135
Mailing Address - Country:US
Mailing Address - Phone:860-659-2779
Mailing Address - Fax:860-633-9315
Practice Address - Street 1:15 CONCORD ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2135
Practice Address - Country:US
Practice Address - Phone:860-659-2779
Practice Address - Fax:860-633-9315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT016895174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001168954Medicaid
HAS536OtherOXFORD/UNITED HEALTHCARE
713297OtherCONNECTICARE
B84184Medicare UPIN