Provider Demographics
NPI:1538279088
Name:RICHARD ROSEFF, MD LLC
Entity Type:Organization
Organization Name:RICHARD ROSEFF, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-743-9596
Mailing Address - Street 1:105 NEWTOWN RD # B
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4194
Mailing Address - Country:US
Mailing Address - Phone:203-743-9596
Mailing Address - Fax:203-743-7597
Practice Address - Street 1:105 NEWTOWN RD # B
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4194
Practice Address - Country:US
Practice Address - Phone:203-743-9596
Practice Address - Fax:203-743-7597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027620207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110007192Medicare ID - Type Unspecified
A56842Medicare UPIN