Provider Demographics
NPI:1629008131
Name:ROSOKOFF, JAMES STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:STEPHEN
Last Name:ROSOKOFF
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 1:15 CONCORD STREET
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033
Mailing Address - Country:US
Mailing Address - Phone:860-659-2779
Mailing Address - Fax:860-633-9315
Practice Address - Street 1:15 CONCORD STREET
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033
Practice Address - Country:US
Practice Address - Phone:860-659-2779
Practice Address - Fax:860-633-9315
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT16895207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT713297OtherCONNECTICARE
CTHAS536OtherOXFORD
CT001168954Medicaid
B84184Medicare UPIN
CT070000083Medicare ID - Type Unspecified