Provider Demographics
NPI:1528023181
Name:CHOSAK, ROSLYN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSLYN
Middle Name:
Last Name:CHOSAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CHURCH ST SOUTH
Mailing Address - Street 2:SUITE 501
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1717
Mailing Address - Country:US
Mailing Address - Phone:203-562-5439
Mailing Address - Fax:203-624-5157
Practice Address - Street 1:2 CHURCH ST S
Practice Address - Street 2:SUITE 501
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1717
Practice Address - Country:US
Practice Address - Phone:203-562-5439
Practice Address - Fax:203-624-5157
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT022991207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1051396OtherAETNA
CT010022991CT02OtherANTHEM
CT764-353OtherCONNECTICARE
CT061364353OtherUNITED HEALTHCARE
CTNHP086OtherOXFORD
CT06-1364353OtherFED TAX ID
CTOQ2292OtherHEALTHNET
CTPR02145640001OtherCIGNA
CT764-353OtherCONNECTICARE
CT010022991CT02OtherANTHEM